F V M A ADVOCATE ISSUE 5 | 2020
In Loving Memory FVMA Executive Director Philip J. Hinkle | 1961-2020
President's Message Dear Colleagues, 7207 Monetary Drive Orlando, Florida 32809 Phone – 407.851.3862 Toll-free – 800.992.3862 Fax – 407.240.3710 email@example.com | www.fvma.org
The amazing and tireless FVMA team continues to serve the veterinarians of Florida. With the loss of Phil Hinkle, FVMA veterans, Ms. Ann Wade and Mr. Jim Naugle, have stepped in as interim executive director and interim deputy executive director, respectively. They have supported and guided the staff, and headquarters is operating at its usual level of excellence. Please reach out if you need any assistance or information.
Dr. Mary Smart President Dr. Marta P. Lista President-elect Dr. Donald H. Morgan Treasurer Dr. Michael Epperson Past President
DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Thomas E. Hester District 2–Northeast Dr. Todd Fulton District 3–Central Dr. Donald S. Howell District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Robert L. Swinger District 6–South Florida Dr. Barbara Lewis District 7–Southwest Dr. John R. Wight District 8–Northwest Dr. Christine M. Storts District 9–Space Coast Dr. Ernest C. Godfrey AVMA Delegate Dr. Richard B. Williams AVMA Alternate Delegate Dr. Jacqueline S. Shellow FAEP Representative to the FVMA Executive Board Dr. Dana Nicole Zimmel Dean, Ex Officio
As I was inventorying my mask collection today, I thought about how different life is for all of us. I was certainly hoping we would be “normal” by now. As that has not materialized, I find myself redefining my expectations. I have had several friends comment about engaging in outdoor activities which they had never tried before. I have a colleague I walk with. It is amazing how many steps you can get in while talking about the daily occurrences in veterinary practice. Another friend has taped these questions to her computer: Daily Quarantine Questions 1. What am I grateful for today? Who am I checking in with or connecting with today? 2. What expectations of “normal” am I letting go of today? 3. How am I getting outside today? 4. How am I exercising today? 5. What beauty am I creating, inviting or seeing today? I think now, more than ever, it is important for us to reach out to each other for our own wellbeing and that of our colleagues and team members. We are strong when we stand together and support each other. It also helps to buffer the trials we are all facing. The AVMA annual convention was hosted virtually on July 30–August 2. The House of Delegates conducted meetings supporting our profession on a national level. Our 92nd FVMA Annual Conference is scheduled for March 11–14, 2021. We hope it will be an in-person meeting, and are exploring all options to host a safe, successful and educational event. The FVMA has also launched FVMA LINK, your live interactive network for knowledge, where live, low cost CE webinars are being offered each week throughout 2020 and beyond. On-demand CE is now available! I hope this finds you all doing well as we continue to navigate these unusual times. With a grateful heart,
Mary Smart, DVM
TO ADVANCE THE VETERINARY MEDICAL PROFESSION, PROMOTE ANIMAL HEALTH AND WELL-BEING, AND PROTECT PUBLIC HEALTH.
Opinions and statements expressed in The Advocate reflect the views of the contributors and do not represent the official policy of the Florida Veterinary Medical Association, unless so stated. Placement of an advertisement does not represent the FVMA’s endorsement of the product or service.
2 | FVMA ADVOCATE
In Remembrance James W. Smith Jr., DVM
Dr. James W. Smith Jr. of St. Petersburg, Florida, passed away on September 11, 2020, at the age of 86 after a four-year battle with cancer. Affectionately known as “Doc Jim,” Dr. Smith was born in Tampa, Florida, and attended Clearwater High School. He served in the United States Marine Corps (USMC), and received the National Defense Service Medal. Dr. Smith then attended Auburn University and graduated with his DVM. He continued to serve in the Marine Reserves for over 20 years while practicing veterinary medicine in St. Petersburg. Dr. Smith established Central Animal Hospital West (49th St.) and East (4th St.) before continuing to
practice part-time for 13 years at Park Animal Hospital. He also served as a lieutenant for the Florida Highway Patrol during this period. Dr. Smith was predeceased by his sons, James W. Smith III and Jeremiah James Smith. He is survived by his wife of 56 years, Barbara; his daughters, Whitney (married to Jim), Lindsy, Jamie (married to Ted), and Julia; and his grandchildren, Monte, Hunter, Jackie, Cassie, Brad, Theo, Thomas Scarpino, and Josiah.
Marc A. Hall, DVM Dr. Marc A. Hall of Winter Garden, Florida, passed away September 26, 2020. He was the fourth child of nine born to Carl and Margaret Hall, in Wolcott, Indiana. Growing up, he always wanted to be a veterinarian. In 1971, he graduated from Purdue University’s School of Veterinary Medicine. Dr. Hall completed additional studies through an internship at the University of Minnesota and authored a number of journal articles. Dr. Hall worked for two successful small animal practices in Fort Lauderdale, Florida, and Cincinnati, Ohio. In June of 1976, he opened Ocoee Animal Hospital. At that time, there were few
other veterinary clinics in Central Florida. He served many clients and their beloved pets until retiring in 2015. Dr. Hall was president of the Central Florida Veterinary Association and a lifetime member of the American Veterinary Association. He remained a member even in retirement and continued to attend annual conferences. Dr. Hall was a devout Catholic and, after retiring, he became a member of St. Vincent de Paul, which runs a food pantry for those in need at St. Andrew Catholic Church in Pine Hills, Florida. He was married to his wife Denise for 51 years. He is survived by his children, Erin Hall, McKenzie Hall (partner Allynne), and Neil Hall (wife Andrea) and three dearly loved grandchildren.
Patrick P. McCallum Jr., DVM Dr. Patrick P. McCallum Jr. DVM, passed away on October 11, 2020. Dr. McCallum graduated from the University of Georgia School of Veterinary Medicine in 1969 after serving in the United States Airforce. In the Airforce, he worked with the military police canine unit where he developed a love for animals. After finishing veterinary school, Dr. McCallum joined Dr. L.P. Murphy at
Murphy Animal Hospital in Tampa, Florida, and eventually took over the practice when Dr. Murphy retired. Dr. McCallum worked there for 35 years as a small animal specialist. He also developed an interest in treating exotic birds and became certified through a program at Busch Gardens. He was a member of the American Veterinary Medical Association (AVMA) and was always a Georgia bulldog at heart. He is survived by his wife, Eleanor; son, Sean; and siblings, Victor, Nona, and Sandra.
In This Issue 4 | Member Spotlight 6 | Common Toxin Emergencies 10 | FVMA Past President Establishes Endowed Professorship to Honor UF Veterinary College Faculty Member
12 | 16 | 26 | 30 | 33 |
The Science of Gratitude A Tribute to Phil Hinkle Feline Pruritus Practice Pulse Classified Advertisements
THE FVMA |
MEMBER SPOTLIGHT FVMA MEMBER,
DR. STEPHANIE JONES,
IS AN INSPIRATION FOR LOCAL YOUTH FVMA member and president of the Broward County VMA, Dr. Stephanie Jones, is an incredible leader with a big heart. A native of Arkansas, she received her bachelor’s degree from Texas A&M in 1994, followed by her DVM from the University of Florida in 1999. After graduation, Dr. Jones moved to Fort Lauderdale and, in 2000, joined the Animal Hospital of Ft. Lauderdale. She is now a co-owner of the hospital. “My time as a veterinarian has been an ever-evolving learning experience,” Dr. Jones said. “I became a veterinarian to ‘help animals’ but through the years I have realized I cannot save them all, so my job is to make their time on earth as comfortable as possible. Veterinary medicine is about providing quality care and quality medicine. It is about client communication and allowing clients to make informed decisions, because at the end of the day that is all you can do: help them come to a decision of compassionate care for a pet, which promotes the human-animal bond and that provides an appropriate quality of life.” In April of 2019, she founded Pets Help The Heart Heal, Inc. This non-profit organization provides an opportunity for vulnerable foster children to learn about veterinary medicine and interact with animals. The program incorporates veterinary medicine and animal industry through events and programs that promote the human-animal bond. “It all started with a smile,” Dr. Jones said. “I was at a local foster care organization helping with a service project and, as we worked on art therapy, I saw the challenges the kids were facing on a day to day basis: bullying, judgement, rejection, abandonment. The one girl that was participating just seemed down. She was doing the assignment but seemed sad. Only when I asked her about bringing my dog here did she show a little glimpse of joy and that frown turned upside down. I began to talk about my job as a veterinarian; I asked questions; they asked me questions. I knew, then, that I needed to do something to bring veterinary medicine and animals into the lives of these kids. At first, it was going to be just a career day at their facility, but so much more could be done at an actual animal hospital.” Dr. Jones' role as president of the Broward County Veterinary Medical Association has helped her spread her message about the benefits of the human-animal bond for youth. She hopes other veterinarians will get involved in this movement by providing learning opportunities in their area. “Many youth that look like me, don’t know careers in animal industry exist for them,” Dr. Jones said. “Providing possibilities 4 | FVMA ADVOCATE
Dr. Jones knows the importance of the human-animal bond. Image courtesy of Dr. Stephanie Jones.
while promoting the human-animal bond is crucial in diversity and representation.” A variety of organizations now participate in her event, Life of Pets and Jr. Vets. During this event, kids go to the Animal Hospital to experience veterinary medicine. In each exam room, kids learn about the physical exam, parasites, household toxins and how to read x-rays to learn about surgery preparation. During breaks, there are puppy love sessions, where kids have an opportunity to play with and learn about different dog breeds. Pets of all ages and types are available. Dr. Jones said the various ages are key. “You never know if the child needs to laugh with a puppy or just sit and pet a gentle, older dog as he lays his head in his/her lap.” The group leaders are instructed to “capture moments” of the kids interacting with the animals, specifically photos of them laughing and smiling. The kids then get to decorate these photos and take them home as a simple reminder of when life was stress free — even for just a moment in time. Dr. Jones and her nonprofit team host this event twice a year. The program also introduces kids to a variety of professions that involve working animals. In addition to her in-person efforts, Pets Help The Heart Heal also makes “comfort packs” to provide essential items and toiletries for foster youth as they transition from one place to the next. Dr. Jones said she feels her purpose is to motivate, encourage and uplift youth.
Dr. Jones speaks to the youth of Jack and Jill Broward Dr. Jones reads to the youth of SOS Village Florida. at the Humane Society. Image courtesy of Dr. Stephanie Jones. Image courtesy of Dr. Stephanie Jones. Pets Help The Heart Heal also partners with the Animal Hospital of Fort Lauderdale to host shadow students. The focus is to provide an in-depth experience as youth see the day-to-day interactions of veterinary medicine. “I feel it is very important for youth to have a full understanding of the career they choose,” Dr. Jones says of her shadow student efforts. “It is vital in making informed decisions about their future.” Before the current coronavirus pandemic, she also ran a Reading with Pets program where she would go to organizations and read to kids. She now provides a virtual version, Reading With Pets Across the Nation, which allows youth in one location to read with pets in a different location. Her goal is to have participants from all 50 states. Dr. Jones got involved with at-risk youth over 15 years ago, when her sister was moving to Maryland and asked Dr. Jones to help finish a program her sister had started for youth at their church.
Pets Help The Heart Heal's biannual event, Life of Pets and Jr. Vets. Image courtesy of Dr. Stephanie Jones.
didn’t want them to lose their identity, but I wanted them to be confident and secure in any situation.” Dr. Jones said she now sees those once-directionless teens doing amazing things. Since then, some of them have graduated from college, joined the military, traveled the world, become master chefs and started families. Some have started investing and are debt free, some tapped into their social media presence and others have pursued graduate programs. "At the end of the day, I just want them to be happy with what they have accomplished and driven enough to keep going, if they want," Dr. Jones said. "I am to be a role model for youth, a representation of things accomplished. I want everyone to know you can have your heart’s desire…just believe. I have been fortunate enough to take my two passions, veterinary medicine and youth development, and bring them together with the purpose to educate, uplift and inspire.”
“I was hesitant to help because, at the time, I didn’t think I had a connection with youth at all,” Dr. Jones said. “As I worked with them, I saw there was a need, simply because they had no vision. When I asked my favorite line: ‘What do you want to do with your life?’ There was nothing. I just got, ‘I don’t know, Dr. Jones.’ I did not understand that answer. ‘Why don’t you know?’ There was no imagination — just the life in front of them.” To combat this, she created a life skills for teens curriculum. Its purpose was to help shape a well-rounded young adult. The participants had to come to class with a vocabulary word each week. The group studied Sean Covey’s 7 Habits of Highly Effective Teens, Jay McGraw’s Life Strategies for Teens and Robert T. Kiyosaki’s Rich Dad Poor Dad for Teens. Dr. Jones took them to restaurants they had never been to and exposed them to different food and different cultures. “We worked on public speaking, etiquette and attire. The goal was to have them be able to adapt and adjust to any environment. I
Dr. Jones hopes to educate, uplift and inspire youth to dare to dream. Image courtesy of Taylor Game Photography.
THE FVMA |
COMMON T XIN EMERGENCIES Tami Lind, BS, RVT, VTS(ECC) Dogs, cats, birds and most animals love to sink their teeth into something that is unknown to them. Unfortunately, this can lead to some major problems and land them in the emergency hospital for toxin ingestion. In 2018, the top 10 toxins that the ASPCA Animal Poison Control Center took calls on were over-the-counter medications; prescription medications; food such as xylitol, grapes, and raisins; chocolate; veterinary products; household items like paint and glue; rodenticide; insecticide; plants; and garden products. A clear patient history and owner’s trust is key to ensuring we can help their pet. If a pet comes into the hospital and a toxin is suspected, but the owners do not know what was ingested, you will have to treat based on symptoms alone. Vomiting, diarrhea, neurologic issues, distressed GI and hypersalivation are just some of the symptoms that can appear due to toxin ingestion. It is vital you ask the client about the possibility of drugs, cleaners, foods, plants and other poisons so that treatment can be as focused as possible. Decontamination is also a very important step when dealing with toxin ingestion. Decontamination is different for different toxins. Decontamination techniques can include bathing for topical toxins or the use of activated charcoal/emesis for ingested toxins. Supportive care after decontamination includes serial monitoring of vital signs and possibly diuresis, dialysis, and monitoring of kidney, liver, and electrolyte values.
Common toxins and treatments: Food:
Chocolate toxicity is most common in dogs. The clinical signs, caused by theobromide and caffeine, include vomiting and diarrhea, tachycardia, muscle tremors, seizures, coma, and death. Decontamination and the administration of activated charcoal are the first steps. Secondary steps would include IV fluid administration, if clinical signs warrant this measure. Propranolol can be prescribed to decrease heart rate, if necessary. With these calculations, you can easily figure out if the amount of chocolate ingested is toxic: • Milk Chocolate: wt (#) x 0.3 = oz needed for reaction • Dark Chocolate: wt (#) x 0.12 = oz needed for reaction • Baking Chocolate: wt (#) x 0.04 = oz needed for reaction Grapes and raisins are also a common food ingested by our canine patients. Unfortunately, the mechanism of action and toxic agent is unknown. These can cause gastrointestinal irritation as well as renal toxicity. The majority of dogs show clinical signs of vomiting 6 | FVMA ADVOCATE
Patient experiencing marijuana toxicity. Image courtesy of Tami Lind. within 24 hours of ingestion. Renal bloodwork changes occur within 24 hours of ingestion and declines around 48–72 hours. Decreased urine output and lethargy can occur after five days. When a patient first presents with grape toxicity, vomiting can be induced. Activated charcoal can be given, but there is limited evidence on if it actually is effective. IV fluids can help preserve the kidneys and keep the patient hydrated. Chemistry values should be monitored over 48 hours. If AKI persists, dialysis may be considered. Xylitol is a sugar substitute showing up in multiple products and people are using it more in baking and cooking over sugar. Xylitol can cause an insulin release in dogs leading to hypoglycemia. If patients ingest higher doses, it can lead to hepatic failure. The effect of Xylitol on cats is widely unknown. When patients come in that have ingested xylitol, vomiting may or may not be effective depending on when they ingested the toxin. Xylitol is absorbed into the body very quickly, so inducing vomiting can prove ineffective. If gum containing xylitol is ingested, inducing vomiting can be effective if the gum was ingested within a short
window. Intravenous dextrose, even in asymptomatic patients, can ensure that patients will not become hypoglycemic. Liver and GI protectants should also be used.
Acetaminophen is a common over-the-counter medication for pain control in humans. When our patients eat this, it can be very detrimental for their health. Cats have an increased sensitivity to acetaminophen. The metabolism of the drug in both dogs and cats can lead to hepatic failure. GI signs occur first, followed by facial edema and cyanosis. Acetaminophen also causes methemoglobinemia, a disorder in which hemoglobin is damaged and hangs on to oxygen instead of releasing it to tissues. This is characterized by brown mucus membranes and chocolate brown blood. Hypoxia occurs in these patients. Heinz bodies can form on red blood cells causing them to be destroyed, and anemia can also occur. Acetaminophen toxicity is treated first with decontamination and activated charcoal. The treatment for acetaminophen is N-Acetylcysteine, (140mg/kg loading dose, 70mg/kg q6h for seven treatments), and can be administered either IV (filter recommended) or PO. N-Acetylcysteine should be diluted to a 5% solution before patient administration. Treatment also can include vitamin C (thought to reduce methemoglobinemia), GI protectants, oxygen and supportive care. Toxic doses of acetaminophen: • Cats: 5–10mg/kg toxic dose • Dogs: >50mg/kg toxic dose Non-steroidal anti-inflammatories, or NSAIDS, are also a common over-the-counter medication that humans take. Clinical signs often include vomiting and diarrhea and can also lead to GI ulceration. At higher doses, renal toxicity can occur. In both cases, decontamination, activated charcoal and GI protectants are recommended. Treatment includes IV fluids and possibly misoprostol to protect against GI ulceration. Chronic use of NSAIDS in patients can result in liver damage.
As there are multiple different types of rodenticides, it is essential to know what type of rodenticide the pet has ingested. Always encourage the client to bring in the packaging that the rodenticide
came in. Color and consistency of the rodenticide cannot always be used because most rodenticides come in a green color and have the same consistency. The three major types of rodenticides are anticoagulant rodenticides, cholecalciferol rodenticides and bromethalin rodenticides. • Anticoagulant rodenticides: Anticoagulant rodenticides inhibit the activity of vitamin K. Vitamin K is required to fully activate coagulation factors II, VII, IX and X. When a patient cannot activate coagulation factors, clinical signs of bleeding are observed. Patients will often come in with a history of coughing up blood, nasal bleeding or lacerations that will not stop bleeding. Other clinical signs can include lethargy, anorexia, weakness and shock. PT/PTT should be tested when anticoagulant rodenticide is suspected as PT/ PTT will be elevated. Vitamin K is the typical treatment for anticoagulant rodenticide. If bleeding is already occurring, blood products should be used. Vitamin K is a fat-soluble vitamin, so it is best absorbed orally with food. If the patient is not eating, it can be given subcutaneously. • Cholecalciferol rodenticides: Cholecalciferol is Vitamin D3 and its ingestion results in hypercalcemia and hyperphosphatemia. This will lead to PU/PD, GI signs, muscle weakness and renal failure. If the patient is seen quickly, emesis and repeated doses of activated charcoal should be used. IV Sodium Chloride should be given for a few days. This reduces calcium reabsorption in the renal tubules and enhances urinary calcium excretion. • Bromethalin rodenticides: Bromethalin is metabolized by the liver into a more toxic product: desmethyl bromethalin. Both products are lipid-soluble, so the bromethalin accumulates in the brain and fat. Brain edema and lipid peroxidation occur and can cause cellular damage and necrosis. Patients may present with ataxia, hind limb paresis, paralysis, seizures, tremors, hyperexcitability hyperthermia, circling, CNS depression and death. Stimulating emesis and activated charcoal are best for decontamination. If the patient is already neurologic, emesis would not be effective. Once the patient develops clinical signs, prognosis is guarded to grave. Lipid emulsion therapy, early in the course of toxicity, has been proposed as a possible “antidote” for this toxin.
Giving patients a bath is a decontamination technique when a topical toxin has been identified. Image courtesy of Tami Lind. WWW.FVMA.ORG |
Pyrethrins are generally used as topical medications for flea repellants. If a feline patient comes in contact with certain topical canine flea medications, they may present with tremors which can be mistaken for seizures. These patients are still aware of their surroundings. When a patient comes in with pyrethrin toxicity, the first treatment should be to bathe them with a dish soap to cut through the medication and remove it. Muscle relaxants can assist with decreasing the muscle tremors. It is imperative that temperature is monitored. IV lipid emulsion has been used and seems to help with the muscle tremors of patients. There are limited studies on the use of lipids with pyrethrins. The most common pyrethroid that the ASPCA Animal Poison Control Center received questions about from Florida was etofenprox. THE FVMA |
This patient was given apomorphine after he ingested rodenticide. Image courtesy of Tami Lind.
Lipids can be used in multiple toxicities. Lipids have a long shelf life and are relatively inexpensive. Image courtesy of Tami Lind. Ivermectin is another antiparasitic that is used for endo- and ectoparasites in dogs and cats. It is available over-the-counter in oral and injectable form. Patients that experience ivermectin toxicity usually present with ataxia, paralysis, bradycardia, blindness, coma or are dead upon arrival. Ivermectin, in high doses, crosses the blood brain barrier and enters the CNS and prevents neuron depolarization. Treatment consists of decontamination, multiple doses of activated charcoal, IV lipids can also be used since ivermectin is lipid soluble. Do not use benzodiazepines to treat seizures as this may not help the seizures.
Sago palms are usually found in tropical areas. All parts of this plant are toxic, and we mostly see feline patients for this toxicity. Cycasin is the most toxic element of the plant. Cycasin can cause hepatotoxicity and is also a GI irritant. It can also cause cerebellar necrosis, which can cause ataxia. These patients will come in with vomiting, diarrhea, melena, icterus, ataxia, and, possibly, seizures and death. There is no antidote, so emesis, activated charcoal, IV fluids and GI protectants will be needed. Sometimes, even with treatment, the patient may need lifelong hepatic support. Canine patients may also come in because they have eaten the seed of the sago palm tree. This can cause a mechanical obstruction and may need surgery. Lilies are found in many gardens and especially in many bouquets around Easter time. All parts of the lily are toxic. If a patient even just nibbles on a leaf of a lily, it can cause toxic effects. These patients will present with vomiting, depression and, eventually, renal failure. If patients are exposed for an extended period of time, they can present with CNS signs which include ataxia, head pressing and seizures. Treatment includes emesis and, if possible, IV fluids, activated charcoal and/or hemodialysis. Kidney values should be monitored daily for 48–72 hours. 8 | FVMA ADVOCATE
Marijuana is starting to become legal in more states and comes in many forms. Pets are exposed via ingestion and secondhand smoke. The active ingredient in marijuana is tetrahydrocannabinol (THC). THC is a depressant that interacts with many neurotransmitters. Patients will present to the hospital with mental depression, hyperesthesia, ataxia, tremors, mydriasis or miosis, hypothermia, bradycardia, and respiratory depression. Patients are also known to “dribble urine” and act like they are falling asleep standing up. With marijuana being laced with more potent medications, patients often come in with more profound clinical signs, leading to coma and possibly death. “Marijuana brownies” are also common with our patients. This can pose two toxin challenges and should be treated at the same time. If a patient comes in quickly after ingestion, emesis can be initiated. Do not induce vomiting if neurologic signs are already present. Activated charcoal can be given with repeated doses. Treatment after decontamination consists of IV fluids and supportive care. THC is a lipid-soluble toxin, so IV lipids can be used to possibly speed up recovery. There are so many more products, plants, food and medications that pets can get into. When a patient comes into the clinic after ingesting a known toxin, it is important that either the owner or your practice calls poison control.
Tami Lind, BS, RVT, VTS(ECC) Tami Lind is the current ICU and ER supervisor at Purdue University. She has been at the university for ten years. She attended the veterinary technology school at Purdue and graduated in 2010 with her bachelor’s degree in veterinary technology. Since then, she has never left! Lind started as a veterinary technician in the ICU, and she has been the supervisor of the ICU/ ER since 2012. She received her VTS in emergency and critical care in October 2016. She enjoys teaching new veterinary technicians and veterinary students. She strives to prepare them for their careers ahead.
Best Friends Forever Pet Moving Solutions Worldwide • Nationwide airanimal.com
Photo credit: www.123rf.com/profile_sam74100
THE FVMA |
FVMA Past President Establishes Endowed Professorship to Honor UF Veterinary College Faculty Member Larry Dee, DVM, and his wife, Rita Dee, have established an endowed professorship honoring emeritus faculty member Dr. Michael Schaer for his contributions to the University of Florida (UF) and the veterinary profession. The Michael Schaer Professorship in Small Animal Emergency and Critical Care Medicine will provide perpetual support of a clinical faculty member associated with the department of small animal clinical sciences and who will work with the emergency and critical care service at UF’s Small Animal Hospital. In the late 1970s, Dr. Schaer accompanied his then-boss on a trip from New York City to the Fort Lauderdale area to give a seminar to the Dee’s local veterinary association. The seminar, one of Dr. Schaer’s first continuing education (CE) lectures, led him to meet Dr. Dee. Later, when Dr. Schaer joined UF in 1978, they became good friends. Dr. Schaer’s time at the college led him to mentor many veterinary alums. Affectionately dubbed “Uncle Mikey,” many fondly remember Schaer’s proscribed rules for practicing veterinary medicine. “Uncle Mikey’s Maxims,” which grew from 10 to more than three dozen, are the result of his impactful experiences in clinical situations. He is also the author of “Clinical Medicine of the Dog and Cat” and “Clinical Signs in Small Animal Medicine.” Dr. Dee comes from a legacy of veterinary medicine in Florida. His late father,
Clarence Dee, DVM, and Clarence’s brother-in-law founded Hollywood Animal Hospital in Hollywood, Florida, where Larry and two of his brothers worked as veterinarians. In the 1970s, Clarence helped support the building of UFCVM, Florida’s only veterinary college, served on the Florida Board of Veterinary Medicine for 20 years and helped establish the Charlie Bild VIP program at UFCVM, which his son, Larry, won in 1982. “Larry is a quintessential professional, an excellent practitioner and a workhorse for the FVMA and the American Veterinary Medical Association,” Schaer told UF’s newsroom. “He’s a great thinker and a wonderful guy who helped spur the growth of the veterinary profession over the past 40 years. There are very few people who have had all of those qualities.” In 1982, Larry Dee became the first Charlie Bild VIP at UFCVM. While there, Dee found Schaer to be immensely helpful. Despite their friendship and shared philosophies on the importance of quality CE, Schaer never saw his friend’s kindness coming. The Michael Schaer Professorship, the first at UF to carry the name of a faculty member, was a complete surprise—and it’s the first professorship at UF dedicated to the support of a clinical faculty member. “Dr. Schaer has influenced so many veterinary students, alumni and other veterinary professionals over the years,
Rita Dee and FVMA Past President Dr. Larry Dee. and this gift is such a meaningful way to honor him,” Dana Zimmel, DVM, the college’s interim dean, told UF’s newsroom. “We are deeply appreciative of the Dee family’s generosity and their ongoing support.” After 34 years of teaching and mentoring veterinary students, interns and residents, Dr. Schaer retired from UF in 2012. Schaer continues to work part time through the UF Small Animal Hospital’s emergency and critical care service and has filled interim administrative roles at the college. He is board-certified in both small animal medicine and emergency medicine and critical care. He continues to lecture at CE conferences and is a routine speaker at FVMA meetings, such as The GulfAtlantic Veterinary Conference and the FVMA Annual Conference. Dr. Michael Schaer. Photo by Jesse Jones.
10 | FVMA ADVOCATE
When treating four-legged patients,
make each moment matter.
PNC can help.
We’re making business banking easier. At PNC, our team of dedicated Healthcare Business Bankers understands your business challenges and the important role that cash flow plays in your success. That’s why we offer a range of solutions to help optimize management of your practice’s revenue cycle and payables, so your business can run with less complexity and payments can be received promptly. Visit pnc.com/hcprofessionals or call 877-566-1355 to learn more.
©2020 The PNC Financial Services Group, Inc. All rights reserved. PNC Bank, National Association. Member FDIC
THE SCIENCE OF
Philip Richmond, DVM, CAPP, CRT, CHC-BCS, CCFP What if I told you there is a tool so powerful it can change your perception of the world around you? It works even on the hectic, challenging days of practicing veterinary medicine. It isn’t some mystical stone from a Marvel movie—it’s gratitude. Gratitude is being aware of and thankful for the good things that happen and taking the time to express thanks.1 It is not only a spiritual principle passed on through generations and cultures. It is an evidence-based intervention that is proven to improve our well-being. Martin Seligman’s widely taught PERMA theory of wellbeing is an acronym for (P)ositive emotion, (E)ngagement, (R)elationships, (M)eaning and (A)chievement. Gratitude falls under the "P" in PERMA. Positive emotions are an important aspect of our overall happiness or subjective well-being. We have a significant opportunity to increase well-being by increasing positive emotion. A landmark study of roughly 1,300 sets of twins demonstrated that our happiness has a genetic component and, generally speaking, we have a happiness set-point.2 Sonja Lyubomirsky, a
12 | FVMA ADVOCATE
world-renown happiness researcher, has expanded on the setpoint theory and shown that overall happiness is determined by three factors: genetics, intentional activity and life circumstances.2 Our set-point can be temporarily or permanently increased by the work we do fostering these intentional activities. The opposite is true as well. If we neglect investing time into our well-being or engage in maladaptive behaviors, our happiness level can shift in a negative direction. Examples of these positive, intentional activities include gratitude practices, mindfulness exercises, working on forgiveness and committing acts of kindness.3
Why Is Positive Emotion Important to Veterinary Professionals? In a study of positive emotion and its effects on physician reasoning, 44 internists were randomized to one of three groups.4 The physicians were placed in a control group or one of two affect-induction groups (induced positive or negative emotion). How were the doctors placed into a positive state? The group was given a bag of candy with a bow on it—that’s all. They weren’t allowed to actually eat the candy, because the sugar could have
affected dopamine levels. This is a validated tool in positive psychology research: receiving a small, unexpected gift induces positive emotion in all of us. After the emotion was induced or control activity completed, the participants were given a standardized case study. The positiveaffect group initially considered liver disease, which was the diagnosis, significantly earlier than the control and negative groups. The positive group also showed considerably less “anchoring”—distortion or inflexibility in thinking. The result was 20% faster and more accurate diagnoses. This is a benefit we all want for ourselves, our clients and our patients.
Ratings of the grateful disposition were correlated with measures of positive emotionality and well-being, including vitality, happiness, satisfaction with life, lack of depressive and anxious symptoms, hope, and optimism.
Correlation between Gratitude, Traits and Behaviors Robert Emmons examined the effect on and behavior correlations of people who scored high on gratitude.5 They demonstrated more satisfaction with life. People showed more pro-social and other-centered behavior (service and cooperation). There was significantly less “maladaptive self-preoccupation.” This is a kinder, more clinical way of saying being less selfish and selfcentered. Finally, those scoring high also showed overall better health and an increased sense of optimism.
Why Does Gratitude Work? Gratitude is effective at increasing our well-being in numerous ways. It increases our overall level of positivity. It feeds positive emotions and allows for an “upward spiral.” Gratitude primes us to be able to recognize the good in the world and the gifts and intentions of our fellows. Our daily experiences are enhanced by gratitude. For example, if you are mindful in the moment of how grateful you are for the opportunity to work in veterinary medicine, the surgical procedure you are about to perform may have a different meaning to you. Gratitude sets the stage to enable savoring. Savoring is fully feeling, living and extending our positive experiences. It counters hedonic adaptation. Hedonic adaptation, or the “hedonic treadmill,” can be best explained like this. You buy a new phone. For a couple weeks, it’s great. After that though, it’s just a phone, right? Gratitude can permit us to be grateful for our home, our car, our job or our phone for the entire time they are in our lives. Feelings of thankfulness counter materialism. We become grateful for what we have, feeling we lack little. Our desire to seek shiny objects, or keep up with the Joneses, is minimized.
How Can We Implement Gratitude in Our Daily Lives? There are a number of evidence-based interventions and exercises to increase our feelings of gratefulness. Here are six practices to increase our level of gratitude: 1. Three Good Things: Name three good things that happened today/this week and what part you played in it. This is the most researched gratitude intervention.6 2. Hunt the Good Stuff: Look around you for things to be grateful for in the moment: a client’s “thank you,” having a vehicle to get you to work, air conditioning, a moment of
THE FVMA |
@FLORIDA_VMA | 13
Induction of positive emotions in physicians allowed for 20% faster and more accurate diagnoses.
4. 5. 6.
hilarity during lunchtime. Widen and sharpen your attention to take in the good around you. Gratitude Visit: Think of someone who has done something that you are grateful for. Write a letter for them in 300 words or less. Tell them exactly what they did and how it made you feel. Meet with them, call or Zoom. Send them the letter a week after your talk so they can relive the experience. This has been shown to have a positive effect for up to a month after the visit.6 Gratitude Apps: Utilize apps such as Gratitude, Grateful or Grateful Chip. Gratitude List: Start writing 10 things you are grateful for. You can also write things down until you can feel a change in yourself. Gratitude Ping-pong/Circle: With another team member/ friend (ping-pong) or with the whole team (circle), each person shares something they are grateful for. Listen to what is important to others. *The University of California-Berkeley Greater Good Science Center’s website (ggia.berkeley.edu) is a great resource and has a list of these practices and more.
Gratitude is a readily accessible tool that increases our level of positive emotion. Regularly practicing thankfulness opens our view to the good in the world around us. Gratitude’s ability to change the lens through which we view the world makes it a powerful tool for veterinary professionals.
1. Peterson, C. and Seligman, MEP. Character Strength and Virtues. American Psychological Press and Oxford University Press, 2004. p. 554. 2. Lykken, D., & Tellegen, A. (1996). Happiness Is a Stochastic Phenomenon. Psychological Science, 7(3), 186–189. 3. Lyubomirsky, S. et. al. Pursuing Happiness: The Architecture of Sustainable Change Review of General Psychology. Educational Publishing Foundation, 2005. Vol. 9, No. 2, 111–131. 4. Estrada, Carlos & Isen, Alice & Young, Mark. (1997). Positive Affect Facilitates Integration of Information and Decreases Anchoring in Reasoning Among Physicians.
14 | FVMA ADVOCATE
Organizational Behavior and Human Decision Processes. 72. 117–135. 5. McCullough, M. E., Emmons, R. A., & Tsang, J. A. (2002). The grateful disposition: a conceptual and empirical topography. Journal of personality and social psychology, 82(1), 112. 6. Seligman, M. E P, Steen, T., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60(5), 410–421.
Philip Richmond, DVM, CAPP, CRT, CHCBCS, CCFP Dr. Philip Richmond is a graduate of the University of Florida College of Veterinary Medicine (UFCVM) and practices in New Port Richey, Florida. He currently serves as the chair of both the Florida Veterinary Medical Association’s Outreach and Professional Wellness & Well-being committees. He is a member of the UFCVM well-being curriculum committee. This committee was formed with the intention to teach wellness and well-being to veterinary students and to create a model for veterinary wellness education in North America. He has also served on the board of directors of the Florida Medical Professionals Group, an organization that supports medical professionals in recovery in the state. Dr. Richmond is a published writer and speaker and is certified in applied positive psychology. He is a certified resilience trainer, certified health coach-behavioral change specialist, certified compassion fatigue professional and a certified QPR suicide prevention gatekeeper instructor. He has earned the Penn Foundations in Positive Psychology Specialization certificate, the BerkeleyX Science of Happiness at Work professional certificate and the AVMA Workplace Wellness certificate. In 2019, Dr. Richmond received an FVMA Gold Star Award for his service. He is married to Dr. Carla Channell, who is also a veterinarian. They have two children, three dogs (an Aussie, a Beagle/ Dachshund, and a Maltese/Affenpinscher), a bevy of cats and turtles, a sulcata tortoise, a ball python, and a corn snake. He is a Krav Maga practitioner and enjoys weightlifting and functional training.
FVMA ANNUAL CONFERENCE
MARCH 11-14, 2021
HILTON ORLANDO BONNET CREEK & WALDORF ASTORIA ORLANDO ORLANDO, FLORIDA
Located at official Walt Disney World ResortÂ® hotels!
WORLD-CLASS CONTINUING EDUCATION FOR EVERY MEMBER OF THE VETERINARY TEAM! (P): 800.992.3862 | (F): 407.240.3710 WWW.FVMA.ORG |
THE FVMA |
Veterinaryloans.com Matching Veterinarians wi th Lenders
Scan now to apply ⇢ Find the Right Fit and Get Connected! One Step Process ⇢ You Apply, We Search! Simple! Quick! And Free! *Over $1,000,000,000 in Loan Requests Processed* ✔ Acquisitions
✔ Start Ups
VETERINARY LOANS.COM No Cost, No Obliga�on!
Call! (877) 288-VETS
Safer, consistent medications.
Shake on it.
Get 10% Off
• • •
Buprenorphine Injection Gabapentin Tablets Tacrolimus Eyedrops
For available strengths/sizes, go to
Offer expires 12/13/20. Not to be combined with other discounts.
Mention Code: FVMA2 (One time use per hospital)
Prescribe with Confidence
THE FVMA |
@FLORIDA_VMA | 23
Registration is open! We're pleased to announce the launch of our virtual continuing education portal! Learn, educate, grow, inspire â&#x20AC;&#x201D; all in the comfort of your home or office.
The FVMA is your LINK to learning!
Your LINK to online continuing education.
VETERINARY CE AT YOUR FINGERTIPS!
INFO@FVMA.ORG 800.992.3862 SIGN UP TODAY!
W WW.FV M A.ORG
A TIRELESS CHAMPION OF VETERINARY MEDICINE
FVMA Executive Director Philip J. Hinkle | 1961-2020
In Loving Memory
Phil was a tireless champion of Floridaâ&#x20AC;&#x2122;s veterinary medical community, and his passion served as an inspiration to everyone here at the FVMA . It is impossible to put into words how greatly he will be missed. Over the course of his 34 years with the FVMA, Phil was known as a leader, mentor and friend. He will forever be remembered as an advocate for the thousands of veterinarians, technicians, practice managers and veterinary assistants in our state.
With the loss of Phil Hinkle, I was forced to consider the magnitude of its impact on those of us left behind—and, more specifically, on myself. Having known Phil for more than 15 years. Having been a part of his family for so long, his children are like my own grandchildren. As a mentor, Phil taught me the art of negotiations. Whether it was that last 5% discount at a hotel, another $1,500 in sponsorship from an industry partner or innovative compensation that exceeded the norm to the benefit of the FVMA. Phil’s achievements at the political level in Tallahassee are legendary. He was responsible for the many protections we in the veterinary field now enjoy—I’m sure his future plans included many more. It was Phil who taught me how to be a warrior for change! As a friend, Phil was always there. In good times or bad, he met each challenge with 120% of himself to make it right. Whether I was buying a house, car or suffering medically, he was always there. One cannot remember Phil without a comment about his unique, one-of-a-kind story telling—he was a master! I remember laughing until I cried no matter how often I heard the same story. He had so many, and should have had so many more Phil will always be remembered most as a man of faith and a man who loved his family and his work at the FVMA. Rest in peace my friend. Ralph Huber Director, Corporate Accounts & New Business FUJIFILM SonoSite, Inc Philip Hinkle will be missed by many. I feel most fortunate to have known him for a number of years in relation to the printing that is done by FVMA. A number of employees at Baker Press were routinely involved with the FVMA’s projects. It was a perfect fit for both companies. Phil was always very involved on all levels with the jobs that came to us. It was his energy, creativity, persistence and ability to bring everyone together on the same page that helped it work time after time over the years. It was always exciting and rewarding to all those involved. It is an experience I will always cherish. Wil Steiner, Account Executive Charles Baker, President Baker Press Phil was the best. He always had the right answer and a great delivery. I had great respect for him and was deeply saddened to hear of his passing. Larry W. Coen, DVM
I first met Phil when I was an alternate delegate to the AVMA almost two decades ago. From the beginning we connected, probably because we were both meticulous, perfectionists and bold—and because we both enjoyed working hard and playing hard. During my six years as AVMA’s District IV Director, our friendship grew immensely. Phil made me feel as if I was a lifelong member of the FVMA, and always treated me like family. Phil was an amazing human being that cared deeply for Florida veterinarians. He was a visionary leader who was admired by many in our profession, including veterinarians, UF faculty and students, industry, and AVMA volunteers, leadership and staff. As I have said before to the FVMA Board, Phil was, in my opinion, the best executive director in the nation. The profession has lost one of its greatest advocates—and I feel as if I have lost a brother. My deepest condolences to Janet, Amber, Ashley, Michael and the entire Hinkle family—you all know that you will always have family in Puerto Rico. May Phil rest in peace, José V. Arce, DVM AVMA President-Elect Phil Hinkle worked tirelessly to advance the FVMA, its members and veterinary medicine. His enthusiasm and energy were unbelievable. Phil was always looking five-10 years down the road. He was fiercely protective of our profession. I think Phil put the FVMA ahead of everything else in the world except for his family. Phil's family, especially his grandkids, was the light of his existence. Janet was his best friend, protector and soulmate. Phil was my friend. I will miss him forever. I think of him every day. Ernie Godfrey, DVM AVMA Delegate (2016-2022) Phil Hinkle will be sorely missed by the FVMA and AVMA. He was passionate about veterinarians and the veterinary profession. It was very personal to him, and he worked with relentless energy to promote and protect the profession. He looked out for his veterinarians. Whenever an issue arose, at the state or federal level, Phil was available to discuss and help. When the AVMA wanted to work with the FVMA to have veterinarians in Florida meet or connect personally in the state with Florida’s members of congress to address a federal legislative issue, he always helped to make it a success. Even when he was battling cancer, he would lead the charge between treatments. I fondly recall spending time with Phil and FVMA leadership in Tallahassee working hard to oppose a bill that would have allowed emotion-based damages in litigation against Florida’s veterinarians. We testified before a committee and spent the day meeting with legislators. Most of them knew Phil on sight, and their respect for the profession was obvious. Moreover, Phil was my friend. Losing Phil has left a large void that will be hard to fill, for the profession, for his colleagues and his family, and for his many, many friends. Kent McClure, DVM, JD Chief Government Relations Officer American Veterinary Medical Association
I was blessed to meet Phil 10 years ago as a representative for my district. Phil was the executive director of the FVMA at that time and he had been with the FVMA for almost 20 years. His passion for the profession was clear from the start. He was a large presence in the board room. Throughout the years, there were numerous issues that came up that the board had to manage. With Phil’s leadership as our executive director, we always felt that there was no issue in the state of Florida that was too big. It was often said he was the FVMA and we all knew it. During my tenure as FVMA president, I saw firsthand how the association grew, both as a presence in the state and financially as an association. The FVMA is now also able to offer many more continuing education events throughout Florida to support veterinarians and their staff. On a personal basis, I miss his stories, especially those about his family. He was a true family man. He loved his family like no other. He was so proud of his children and the people they had become. He loved his grandbabies and would light up just thinking about them. He would go on and on to anyone that would listen. His wife, Janet, was always by his side. They were quite a team. Phil accomplished a lot in his tenure at the FVMA, but I guarantee he would not have been able to accomplish as much as he had without the love and support of his wife. Quite frankly there will never be another person like Phil Hinkle. I miss him and I miss his mentorship and friendship. I miss his positive outlook on life. Sure, he had his rants, but at the end of the day he saw the best in people. He wanted the best for people—and if you were a veterinarian, veterinary student, or a member of the veterinary support team, you were his kind of person. He would do everything he could in his power to protect you, support you and improve the quality of your life. See, we all lost a lot when we lost Phil. The FVMA lost a visionary, leader and a true champion of veterinary medicine. His family lost their dad, husband and papa. Veterinary medicine lost a pioneer for years to come. I can assure you the FVMA is better off for his leadership and the practices he had put in place for years to come. Whether you knew him or not, if you were a veterinarian, veterinary student, or support staff he changed your profession for the better. That is his legacy. Michael Epperson, DVM FVMA Past President In March of 2017, I was blessed with the opportunity to work at the FVMA in the membership department. Through the years, I have been fortunate to be part of this amazing, growing organization. Under the remarkable leadership of our late Executive Director Philip Hinkle, I have learned a great deal about the industry, association and its operation. Phil was a courageous and renowned leader, who I am so pleased to have worked with. I have been encouraged and empowered under Phil’s leadership. Working here has given me drive not only at work, but also in my personal life. Phil was and always will be an inspiration and a role model to me, and I will continue to provide the world with his legacy of giving the BEST at the FVMA. It was a pleasure and an honor to have met you and been part of your mission, Phil. I will forever and always miss you. I truly thank you for your guidance, wisdom, strength and drive. Rest in peace Phil, your legacy will continue. Erica Tomberlin FVMA Membership Representative
These last few months have been challenging times for our family. Our loss is great, and our grief feels, at times, unsurmountable. Yet, as we look back, we are reminded of the countless amazing memories we had with our beloved husband, father and papa, Philip James Hinkle. There are countless memories, but one that tops the list, after family and faith, is the Florida Veterinary Medical Association. Many people have stated Phil was the FVMA. Phil went to work for the FVMA at an entry level position in the early 1980s. He was an energetic, motivated and enthusiastic young man desiring to expand his career and become the best provider for his wife and then-growing family. After a few years, Phil began to realize the possibilities available to the FVMA. Phil was a visionary and had innovative ideas to strengthen membership and make the FVMA more productive than ever. He was so passionate about animal advocacy. His excitement for life, dedication, work ethic, commitment, strong communication and negotiating skills, and his heart “for the right thing” advanced him within the organization. There was never a time he did not put his heart into his work. He loved the FVMA and the members he served—loving them with his huge heart and treating them like family. His aspirations for the FVMA flowed through to his wife and family. We were his fan club. Janet (his wife) saw his enthusiasm and dedication to the FVMA and knew how much it meant to him. She was his admiring advocate and sounding board as he worked long hours to fulfill his dreams, dreams... which somehow seemed to infect each of us with contagious enthusiasm and interest. In 2007, Phil interviewed for the position of executive director. He was excited and nervous as potential candidates flew in from all over the country vying for the position. While he was nervous, we had faith he would do amazing. He was not only qualified, but the most passionate and charismatic candidate they would interview. We were ecstatic when he was chosen for the position. Along with meeting his precious wife and creating a beautiful family, accepting the executive director position was one of Phil’s proudest accomplishments. While Phil was a visionary, he was also a man who knew how to achieve his goals and turn his vision into a reality. With a smile that could light up a room, conference time was his time 17| FVMA ADVOCATE
to shine. As we would describe it, he was like a kid in a candy store. When Phil would walk into a room, it would come alive with laughter, knowledge and friendship. He did not see the FVMA as a job but rather as another passion in his life. Our family looked forward to conference time as much as he did. He loved sharing the love of his family with his coworkers, colleagues and anyone that he came across—anyone who would listen. Our entire family helped with the conferences and many meetings throughout the years. As our family grew, even the in-laws and rescue Pomeranians, Toby and Tyler, would attend. From helping with the registration desk to setting up the audio for lectures, we enjoyed being part of the FVMA family. We knew what our father expected and we were determined and enthusiastic to help make it happen. When our family expanded and Phil became a “Papa," he was proud to introduce everyone to his grandchildren—Elijah James, Jeremiah, Hannah, JoJo, Ella and Austin. He paraded his grandbabies throughout the exhibit halls and brought them to dinners with his admiring wife by his side. While he was parading his family around showing everyone how proud he was of us all, we were so proud to be the family of such a loving, kind and hardworking man! Phil’s passion for the veterinary industry has and will always live within us. He had such a big heart and always expressed his love. We were always proud of how many people loved and respected him and valued his opinions. He was a mentor to many and a friend to even more. During the following years, we observed Phil’s enthusiasm as he grew and expanded the FVMA to heights and success that many did not think was possible. Phil may have been the face of the FVMA, but Janet was also always in his corner, supporting every dream and courageous idea he shared. The FVMA was part of their daily routine.
but also his work family. Although he was still healing from surgery and needed to rest, he asked his wife to drive him to the office to see the staff he missed so much. Work was a second home to him—he had missed home. He was greeted with smiles and cheers, and it meant so much as he witnessed their love and support. Unfortunately, our hearts were shattered when our dad, the best papa there ever was and our mom’s soulmate, passed away very unexpectedly. It has left an indescribable void in our family. We have enjoyed hearing all the stories of the impact Phil has had on the veterinary community and we could not be prouder of his accomplishments and the relationships he built. We feel so blessed to have been part of the FVMA and are thankful for all the amazing support we have received from each of you. The FVMA has been part of our family for over 34 years and we pray Phil’s legacy and passion will live on with the same success he dreamed of and envisioned. Any present and future success will honor his hard work and loyalty to the FVMA, an organization he so passionately believed in.
While Phil was having tremendous success at work and had a beautiful family life, he was also a warrior battling cancer. He was first diagnosed in 2014. He endured multiple surgeries, procedures, chemotherapy and treatments. Regardless of the amount of procedures, chemotherapy treatments, travel, quarantining, fatigue and side effects, Philip Hinkle never stopped. He always showed up to work. It did not matter what he was facing in his personal life, he was always devoted to the success of his career and veterinary medicine. God placed Phil in this profession to be a dedicated leader, an advocate, a warrior and a role model for whoever crossed his path. He never complained about how he felt. When asked his response was always the same: “I am a blessed man!” After several years of treatments that included many ups and downs, Phil was more determined than ever to beat cancer. With his wife by his side, they sought out specialized care at Memorial Sloan Kettering Cancer Center (MSKCC) in New York. There he received innovative treatments and procedures.
Thank you for being part of our lives and supporting Phil and Janet through all their endeavors. We appreciate all your love, support and prayers as we navigate our new normal— without our beloved husband, father and papa. May he always be a reminder of faith, family, love, dedication and passion for the veterinary community. The Family of Philip James Hinkle Janet (his loving wife); his children, Amber (Dan), Ashley (Charlie) and Michael (Cynthia); and grandchildren, Jeremiah, Hannah, JoJo, Ella, and Austin
With his most recent surgery at MSKCC, we received amazing news. The oncologist and surgeon deemed him cancer free. He did it! Phil could not wait to get home to celebrate this huge victory with not only his family WWW.FVMA.ORG |
THE FVMA |
@FLORIDA_VMA | 18
Health Insurance Inspired by You AVMA members, their employees, and their family members now have access to affordable health care through the AVMA Trust Association Health Plan (AHP). • 100% coverage of rabies vaccine and titer testing in PPO plans • No health information required to enroll • No restrictions on pre-existing conditions • Premium rates are guaranteed through December 31, 2021 For eligibility and enrollment, visit:
24 | FVMA ADVOCATE
Did you know
FVMA OFFERS MEMBERSHIP FOR YOUR ENTIRE VETERINARY PRACTICE? Veterinary Practice Managers (VPM) In addition to veterinary memberships, the FVMA also offers memberships for your entire veterinary care team. We certify veterinary assistants and technicians to become Certified Veterinary Assistants and Certified Veterinary Technicians. We also offer membership to Veterinary Practice Managers and Animal Care Technicians. Learn more about how the members of your team can become members of the FVMA and enjoy the benefits of membership.
Prerequisites: • Verification of on-the-job training by a licensed veterinarian. • Serving a veterinary clinic as an office administrator, financial manager, etc. • $55 dues fee required every two years. Current expiration: 12/31/2023
Animal Care Technicians (ACT) Prerequisites: • Verification of on-the-job training by a licensed veterinarian. • Veterinary team member who has worked in the capacity of a technician for at least three years. • Any graduate of an AVMA-accredited veterinary technology program who does not qualify for a technician certification. • $35 dues fee required every two years. Current expiration: 12/31/2023
Certified Veterinary Assistants (CVA)
Find all the information on these memberships on the FVMA website: www.fvma.org/team-members/ To add your veterinary practice team member to the FVMA, contact us today at 407.851.3862 or email us at firstname.lastname@example.org for more information.
Prerequisites: • Complete at least nine months of an ACT approved high school or adult learning program. • Complete the “Skills Competency Validation Checklist” under the supervision of a licensed DVM, CVT and/or approved veterinary assistant instructor (VAI) where applicable. • Complete a minimum of 500 hours of practical veterinary assisting experience. • At least 250 hours must be in a veterinary hospital setting working with live animals. • Up to 250 hours can be school lab time, defined as non-lecture time, wherein the student applicant performs and appropriately utilizes related veterinary assisting skills under the supervision of the VAI. • Score 70% or higher on the CVA Final Exam. • $25 dues fee required every year. Current expiration: 12/31/2021
Certified Veterinary Technicians (CVT) Prerequisites: • Graduate from an AVMA-accredited veterinary technician program. • Obtain a passing grade in the Veterinary Technician National Exam (VTNE), which is administered by the American Association of Veterinary State Boards (AAVSB). • $55 dues fee required every two years. Current expiration: 12/31/2023
THE FVMA |
F LINE PRURITUS Amelia G. White, DVM, MS, DACVD
INTRODUCTION Allergies in cats are one of the most challenging and frustrating medical conditions we deal with as veterinarians. This is largely due to the severity of dermatological lesions, significantly decreased quality of life, limited medical therapy options and difficulty administering medications to cats. Cats tend to develop significant psychogenic components to pruritic behaviors that need to be addressed in order to maintain adequate control of the clinical signs.
Types of Allergy in Cats
There are several types of allergies in cats and the most common include flea bite hypersensitivity, mosquito bite hypersensitivity, atopic dermatitis and adverse food reaction (food allergy). Each of these conditions creates significant pruritus and dermatitis that Prominent lesions of the eosinophilic granuloma complex. Rodent ulcer on the upper lip. can lead to self-mutilation and severe secondary bacterial and Image courtesy of Dr. Amelia G. White. fungal skin infections. These allergies are not curable, but, with a thorough understanding of which allergies are problematic for the cat, they can be well-managed long term.
The Eosinophilic Granuloma Complex/ Syndrome
Cats are unique in that they tend to develop similar dermatological lesions despite a differing causative allergy. In general, cats tend to develop lesions infiltrated with eosinophils. Lesions are highly pruritic to the point of self-mutilation. The classic lesions that make up this complex are: 1) miliary dermatitis (tiny millimeter sized crusted papules), 2) eosinophilic granulomas (mouth, lateral pelvic limbs or interdigital), 3) rodent/indolent ulcer (eosinophilic ulcer on upper maxillary lip margin) and 4) eosinophilic plaque (ventral abdomen or dorsal head). Identifying these lesions on a cat is helpful in understanding that an allergy is most likely driving the dermatological abnormalities. Additional workup is required to determine which allergy or allergies play a role. Prominent lesions of the eosinophilic granuloma complex. Multiple eosinophilic granulomas on the medial pelvic limb. Image courtesy of Dr. Amelia G. White.
FLEA BITE HYPERSENSITIVITY Pathogenesis
Flea bite hypersensitivity, or flea allergy, is the most common type of allergy in the cat (and in the dog). It occurs when the cat is sensitized to flea salivary proteins. While in dogs it has been demonstrated that intermittent flea exposure is associated with
26â&#x20AC;&#x201A; |â&#x20AC;&#x192; FVMA ADVOCATE
Avoidance of flea bites is the most effective treatment for a flea allergy. This can be very challenging, especially in households with numerous animals or outdoor cats. If you suspect a flea allergy in a cat, all animals in the household (even if they are indoor-only animals) and the environment should be routinely treated for fleas. Typically, animals allergic to fleas will receive two forms of flea control, most commonly combining a topical agent with an oral agent. One of these agents should contain a repellent to discourage flea bites. It generally is best to hire a professional exterminator to treat the environment.
Prominent lesions of the eosinophilic granuloma complex. Large eosinophilic plaque on the lateral thorax. Image courtesy of Dr. Amelia G. White.
Anti-inflammatory and antimicrobial therapies may be required in some cats according to clinical and cytological findings. Glucocorticoids are fast and highly effective for flea-allergic cats. Remember that cats have fewer steroid receptors and generally require a slightly higher anti-inflammatory dose as compared to dogs. Oral prednisolone (2mg/kg/day) on a tapering schedule over a few weeks will provide short-term relief. Methylprednisolone
a higher risk of developing flea allergy, the opposite is true for cats. Commonly, cats with flea bite hypersensitivity have other concurrent allergies.
Clinical Signs There is no age, breed or sex predilection for a flea allergy in the cat. Cats are extremely pruritic and develop miliary dermatitis, pustules, alopecia, erythema, and excoriations on the head, neck, caudal dorsum, abdomen, and distal extremities. Lesions of the eosinophilic granuloma complex develop overtime including eosinophilic granuloma, eosinophilic plaques and rodent ulcers.
Cats receiving routine flea control can still display clinical signs consistent with flea allergy if a heavy flea burden exists within their environment. If lesions are distributed in the caudal half of the cat, this can be helpful in making a diagnosis when coupled with historical information. Finding fleas or flea dirt on the cat shows evidence of flea exposure but does not rule in/out the diagnosis of a flea allergy. Likewise, high serum IgE or positivity for intradermal flea antigen does not confirm the diagnosis of a flea allergy. Other parasites and allergies, along with bacterial and fungal infections, must be excluded as these diseases cause identical dermatological lesions. Several diagnostics can help work through these differentials, including cytology to evaluate for bacterial and fungal infections, skin scrapings to evaluate for parasites, and bacterial and/or fungal cultures. Histopathology can support the diagnosis of an allergic etiology but is not a diagnostic for a flea allergy. Well-demarcated, self-induced alopecia on the dorsum extending to the tail base in a cat with flea allergy dermatitis. Image courtesy of Dr. Amelia G. White. WWW.FVMA.ORG |
THE FVMA |
@FLORIDA_VMA | â&#x20AC;&#x201A;27
Diagnosis is achieved through history, physical exam and ruling out other diseases. Other diseases to consider include other allergies, pyoderma, fungal dermatitis, demodicosis, Cryptococcus infection, ulcerative herpes virus dermatitis, pemphigus foliaceus and contact reaction. Histopathology does not provide a definitive diagnosis, but does support an allergic etiology. High serum IgE or positivity for intradermal mosquito antigen does not confirm the diagnosis of mosquito bite allergy.
Mild alopecia, erythema and edema of the dorsal muzzle in a cat with mosquito bite hypersensitivity. Similar lesions were present on the lip margins, chin, ear pinnae and paw pads. Image courtesy of Dr. Amelia G. White.
acetate (DepoMedrol) (10–20 mg per cat, once every 8–12 weeks) may be a better choice for cats that are difficult to medicate. Antihistamines and omega fatty acids will decrease inflammation in mildly affected cats, but it may not provide enough relief for most cats. Allergen-specific immunotherapy is not effective.
Overall, prognosis is good if the flea bite can be avoided. Oftentimes, this disease will wax and wane with changes in environmental flea burden, acquisition of new pets, boarding/ grooming, etc.
MOSQUITO BITE HYPERSENSITIVITY Pathogenesis
Similar to flea bite hypersensitivity, mosquito bite hypersensitivity is an allergic response to a mosquito bite. It is thought to be a Type I reaction with most lesions developing within 20 minutes.
Clinical Signss There is no breed, age or sex predilection. This disease is variably pruritic. Lesions originate at the site of the mosquito bite most commonly on the head, pinna and bridge of the nose. Lesions may extend to include eyelids, footpads, chin and lips. Outdoor cats are more severely affected, but indoor cats can be affected especially in geographical locations with heavy mosquito populations (e.g. humid, temperate regions). Dermatological lesions begin as pruritus, wheals, papules and plaques. Over time, lesions become nodules, crusts, excoriations, alopecia and changes in pigmentation.
28 | FVMA ADVOCATE
Confining cats to an indoor lifestyle, treating the environment for mosquitoes, removal of mosquito breeding sites (e.g. standing fresh water) and treating the cat with a flea preventative with repellent activity (e.g. Seresto® collar) will reduce the clinical signs. Clinical signs can wax and wane based on the environmental burden and time of year. Use of glucocorticoids as above for flea allergy is highly effective to control pruritus and dermatitis associated with mosquito bite hypersensitivity.
Prognosis is usually good if mosquito bites can be avoided and if cats adapt to the indoor lifestyle.
ATOPIC DERMATITIS Pathogenesis
Atopic dermatitis is a hypersensitivity typically characterized by high levels of IgE to environmental allergens such as plant pollens, molds, insects and mites. Sensitization occurs primarily transcutaneously through recognition of environmental antigens via epidermal dendritic cells (e.g. Langerhans cells) and presentation of naïve T cells in nearby lymphoid tissue. Upon presentation, these naïve T cells skew towards a Th2 response and lead to overproduction of pro-inflammatory cytokines (e.g. IL-2, IL-4, IL-13, IL-31). Typical presentation of disease occurs in young adulthood, unless a cat has recently moved to a new geographic location.
The most common clinical signs are extreme pruritus originating on the head and neck and progressing throughout the body especially on the ventrum, lateral thorax and distal extremities. Miliary dermatitis, eosinophilic plaques/nodules, rodent ulcers, pustules, alopecia and excoriations.
Much like the other feline allergies, atopic dermatitis is a diagnosis of exclusion. The diagnosis based on history, physical exam findings and ruling out other pruritic diseases. Other diseases to consider include other allergies, pyoderma, fungal infections and parasitic infections. Serum IgE concentrations and
intradermal reactivity are not diagnostic for atopic dermatitis. Histopathology does not provide a definitive diagnosis but does support an allergic etiology.
Treatment is aimed at reducing inflammation since allergen avoidance is nearly impossible. Allergen-specific immunotherapy remains the gold standard and can be formulated from serological or intradermal test results. Intradermal testing in cats is very difficult because cats have less profound and long-lasting wheal and flare reactions as compared to dogs. For this reason, serology is frequently used to formulate immunotherapy in cats. Effective anti-inflammatory medications include glucocorticoids, antihistamines, omega fatty acids and cyclosporine (Atopica®). Apoquel® (oclacitinib) has been attempted off-label in cats but is not very effective unless dosed twice daily, and one study has suggested that methylprednisolone is more effective than Apoquel to manage allergic disease in cats. The safety and efficacy of oclacitinib is unknown in the cat. Cytopoint® is a monoclonal canine antibody and should not be used in the cat due to the possibility of a severe anaphylaxis in response to foreign canine antigens.
avoided. Novel protein diets are less commonly used in patients with unknown dietary histories or cats that have been exposed to many diets already. Resolution of clinical signs is suggestive of the diagnosis, but a dietary challenge is required to confirm the diagnosis. Single ingredient challenges can be performed to better understand which food antigens are a problem so that an over-the-counter diet can be selected. Oftentimes, clients continue to feed the diagnostic diet for life in order to avoid recurrence of clinical signs. Most of the veterinary-formulated, diagnostic diets for food allergies are approved for long-term feeding.
The avoidance of problematic food ingredients will prevent clinical signs. It can be difficult to prevent all clinical signs if owners are unable to maintain a restrictive diet (e.g. outdoor cats). Glucocorticoids or cyclosporine (Atopica®) are initially helpful in reducing inflammation and itchiness.
If food allergen avoidance is possible, prognosis is good.
Prognosis is poor for a cure but good for long-term control. Refractory cases of atopic dermatitis can carry a poor prognosis if they fail to respond to traditional therapies. These cases are less common in occurrence and typically warrant referral to a veterinary dermatologist.
ADVERSE FOOD REACTION: FOOD ALLERGY Pathogenesis
A food allergy is typically a hypersensitivity to one or more food ingredients; dietary proteins are most commonly implicated. Other ingredients less commonly implicated include cereals/ grains, dyes and preservatives. The mean age of onset in the cat is two-five years of age with Siamese cats overrepresented.
Pruritus is the most common clinical sign along with eosinophilic granuloma complex lesions, alopecia, excoriations and pustules. Gastrointestinal disturbance occurs in 10–15% of cases including vomiting, diarrhea, weight loss and picky appetites.
Amelia White, DVM, MS, DACVD Dr. Amelia White received her DVM from the University of Georgia College of Veterinary Medicine in 2010, followed by a one-year internship in small animal medicine and surgery at Auburn University. She was accepted to a dermatology residency at the University of Illinois at ChampaignUrbana the following year, where she completed three years of specialty training and a master’s degree in 2014. Dr. White completed her board certification exam in veterinary dermatology in fall 2014 and became a diplomate of the American College of Veterinary Dermatology. She currently is an associate clinical professor of dermatology at Auburn University College of Veterinary Medicine. She has authored or contributed to various abstracts, case reports, primary research and a book chapter in her short career. Dr. White has been a consultant for the Veterinary Information Network (VIN) since 2015. She teaches the communications skills course at Auburn University and enjoys opportunities to provide continuing education seminars to veterinary professionals. Her research interests include allergic skin and ear diseases, infectious diseases, and student mental health and well-being.
The only effective diagnostic test is a dietary elimination trial. Typically, a novel protein or hydrolyzed veterinary-formulated diet is preferred and is fed exclusively for eight-12 weeks. Flavored medications, supplements, treats and other food additives must be
Practice Pulse QUESTION: I have a situation regarding a puppy that was sold with a health certificate. Not more than a week after, the puppy was not eating well and began having seizures. What is my client’s recourse in a situation like this? Can she get a refund from the breeder? A: Florida’s Pet Lemon Law—828.29 Dogs and cats transported
or offered for sale; health requirements; consumer guarantee —offers protection for the buying client in instances where a dealer may misrepresent the breed, sex or health of any dog sold within the state. Those who purchase a pet that is later determined to be unfit by a veterinarian have three options: • Return the animal for a full refund, including any taxes and fees, and a reimbursement for the veterinary cost related to the dog. • Exchange the animal for one of equal value in lieu of a refund. If they choose an exchange the dog, they are still entitled to veterinary reimbursement. • Keep the animal. Those who wish to retain the dog may do so (unless they signed an agreement waiving this right at the time of purchase). If the consumer chooses to keep the animal, the dealer must pay for reasonable veterinary expenses to treat or cure the dog. The Pet Lemon Law allows the following: • Consumers have 14 days to document contagious or infectious disease and one year to document congenital or hereditary defects. • Consumers must notify the pet dealer within two business days of the veterinarian's determination that the animal was unfit. • Consumers have three days to provide the seller with written certification of the animal’s unfitness.
QUESTION: I am a large animal mobile practice owner. I have a client who has refused to pay an invoice. The client has now taken to emailing lies about me to colleagues and I am worried about what she will do next. I am also uncertain if I should call my insurance provider to warn them, since the client may file a complaint that is based on lies. A friend recommended I contact a lawyer about a cease and desist letter or a recommendation. What should I do? A: A cease and desist letter is an option, but that may induce the
client to file a complaint. The best strategy for situations like this is to ignore them. When you look at a restaurant review on Yelp or TripAdvisor, you may see 100 good reviews and 2 or 3 terrible reviews. You assume that the 2 or 3 are disgruntled customers with a bone to pick. The same is true here. Your good reputation is the best defense. When your colleagues receive those emails, they will assume that this person is an extreme outlier. However, if you receive a notice from the DBPR that a complaint has been filed, then contact your insurance provider.
30 | FVMA ADVOCATE
QUESTION: One of our clients requested Tramadol on 1800PetMeds. We normally have an online portal that makes it convenient to approve the prescriptions or they are emailed to us for the doctor to sign and emailed back. Per a phone call from a 1800PetMeds pharmacist, they cannot email prescription requests for controlled substances, accept a written prescription (because it would be a “copy”) or put this through on our online portal. They do however accept faxed requests, but we do not have a fax machine. They will only accept controlled substances to be called in. This seems strange to me. A: Tramadol is a Schedule IV substance. A prescription for a Schedule II must be written and manually signed. A copy (whether photocopy, fax or PDF e-mail) for a Schedule II is not acceptable. Anything else can be called in, faxed or e-mailed as a PDF.
Electronic prescriptions for controlled substances must be done through systems that meet specific requirements in the Code of Federal Regulations, but those are electronic prescriptions, not emailed or faxed. Emailing a PDF prescription form signed by the prescriber is no different than the same form being faxed. The 1800PetMeds pharmacy can accept an email prescription if it is not for a Schedule II substance. Therefore, it comes down to an issue with the preference of this particular pharmacy, but the reason given is incorrect. A fax is a much a “copy” as a PDF by email. Although a veterinarian does not have to bend over backwards to satisfy any particular pharmacy, this may be a matter of client service.
QUESTION: I am employed as the sole practitioner at a facility. However, my Florida veterinary license lists my home address as I previously worked as a contract vet prior to my permanent employment. Is there any legal reason why I would need to change the address on my vet license to reflect my current place of employment? A: The address on the license should remain the same. That is the
veterinarian’s mailing address. Under the Rule (61G18-10.0065), the veterinarian should send a Certified Mail letter to the Board regarding his current address and “place of practice.” 455.275 Address of record. (1) Each licensee of the department is solely responsible for notifying the department in writing of the licensee’s current mailing address, e-mail address, and place of practice, as defined by rule of the board or the department when there is no board. A licensee’s failure to notify the department of a change of address constitutes a violation of this section, and the licensee may be disciplined by the board or the department when there is no board. (2) Notwithstanding any other provision of law, service by regular mail or e-mail to a licensee’s last known mailing address or e-mail address of record with the department constitutes adequate and
GOT A QUESTION? THE FVMA CAN HELP.
One of the benefits of an FVMA membership is our helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-6 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.
sufficient notice to the licensee for any official communication to the licensee by the board or the department except when other service is required pursuant to s. 455.225. (3)(a) Notwithstanding any provision of law, when an administrative complaint is served on a licensee of the department, the department shall provide service by regular mail to the licensee’s last known address of record, by certified mail to the last known address of record, and, if possible, by e-mail. (b) If service, as provided in paragraph (a), does not provide the department with proof of service, the department shall call the last known telephone number of record and cause a short, plain notice to the licensee to be posted on the front page of the department’s website and shall send notice via e-mail to all newspapers of general circulation and all news departments of broadcast network affiliates in the county of the licensee’s last known address of record. 61G18-10.0065 Notice to the Department of Mailing Address and Place of Practice of Licensee. Each licensee and registrant shall provide by certified mail written notification to the department the licensee’s current mailing address and place of practice upon change thereof or license renewal. The term “place of practice” means the address of the physical location where the veterinarian practices veterinary medicine.
means a legible certificate of veterinary inspection signed by the examining veterinarian licensed by the state of origin and accredited by the United States Department of Agriculture, that shows the age, sex, breed, color, and health record of the dog or cat, the printed or typed names and addresses of the person or business from whom the animal was obtained, the consignor or seller, the consignee or purchaser, and the examining veterinarian, and the veterinarian’s license number. The official certificate of veterinary inspection must list all vaccines and deworming medications administered to the dog or cat, including the manufacturer, vaccine, type, lot number, expiration date, and the dates of administration thereof, and must state that the examining veterinarian warrants that, to the best of his or her knowledge, the animal has no sign of contagious or infectious diseases and has no evidence of internal or external parasites, including coccidiosis and ear mites, but excluding fleas and ticks. The Department of Agriculture and Consumer Services shall supply the official intrastate certificate of veterinary inspection required by this section at cost."
QUESTION: Would “financial records” be the same as “patient records” as referred to in 61G18-18.002? We have received a subpoena from the State Attorney to submit financial records of an active client. Should I share those records, or would I be breaking confidentiality laws?
My question is: Is it the intent of the FDACS to prohibit the issuance of a health certificate (HC) for otherwise healthy dogs and cats, if they have any fleas? Since we do live in Florida, and even very well cared-for pets are susceptible to the occasional flea, this seems like an unnecessarily high hurdle and directly counters the specific wording of the authorizing statute. I can understand not writing a HC for a flea-anemic patient, but I would think that most licensed veterinarians would not consider that patient to be healthy and would not issue a certificate based on that assessment.
A: “Financial Records” are not patient records. However, even if they
A: The doctor is reading too much into the FDACS certificate as the
were, a subpoena trumps any confidentiality concerns.
QUESTION: It has recently come to my attention that the Department of Agriculture and Consumer Services has revised the OCVI for the intrastate sale of a dog or cat (form FDACS-09085). The revision (below) has removed wording from the Issuing Veterinarian Certification that specifically excluded fleas and ticks as a condition prohibiting issuance of the certificate.
certification language referring to fleas and ticks, excludes fleas and ticks—which is the statute’s intent. The ultimate is the law, not the form. The statute says that fleas and ticks are excluded. The form simply abbreviates the language of the statute because it is too long.
Florida Statute 828.29 3(b) specifically spells out the exclusion: "(b) The term “official certificate of veterinary inspection”
END NOTE: The ultimate responsibility
in the practice of veterinary medicine lies with the licensed veterinarian. Professional discretion must always be exercised. WWW.FVMA.ORG |
THE FVMA |
@FLORIDA_VMA | 31
Practices for Sale FL - Central: SA Solo Dr Prx. 3 freestanding facilities and 6.32 acres. >$1M Gross & growing. Well equipped. (FL12A) GA - AAHA Listing! Savannah-Coastal, 1 DVM SA Prx w/RE incl 2 acres, Approx 4084SF spacious facility. Significant opportunities for growth. Well Equipped. 2019 Gross $657K. (GA20S) SC - Greenville & Spartanburg Area: 2+ Dr. SA Prx w/RE on 4+ ac. Plus extra lot on major hwy. >$2M gross & growing. (SC13W) SC - Upstate West South Carolina: 2019 Gross of $2.5M with projected 2020 Revenues >$3M! 2 Doctor SA Prx w/RE Incl 1.6 Acres, Approx 5764SF Spacious Facility. Well Equipped. (SC30W) NC - AAHA Listing-Piedmont Triad/Growing Area: 1.25 DVMs SA, Approx 3000SF spacious facility. Only open 4.5 days a week. Well Equipped. 2019 Gross $685K. PRX & RE $625K. (NC15B) GA - South Central: Grossing >$1M & growing, 1.5 dr. practice. Attractive facility with 5 acres and modern equipment. (GA14F) NC - Northeast, near VA: Calling nature lovers and adventurists! Immaculate, well-equipped facility- digital x-ray, in-house lab, companion laser. $1.1M+ gross, 2 dr., SA w/ LA capability. (NC66G) 1610 Frederica Road, Saint Simons Island, GA 31522 Toll Free: (800) 333-1984 | www.simmonsinc.com Email: email@example.com Licensed in Florida, Georgia, North Carolina, and South Carolina Real Estate Broker
Veterinary Practice Sales, Acquisitions & Valuations
Florida Practice Listings! North Central Fl.– 1+ Dr. 2019 gross $700K, free standing clinic w/ 2 exam rooms, in-house lab, digital x-ray, great staff. Primary Vet in this practice is willing to stay on. Eastern Panhandle– 1 Dr. w/ 2019 gross of $712K, 3200 sq. ft. clinic, 2 exam rooms, in-house lab, digital x-ray. Great small town atmosphere, only an hour from the Gulf Beaches. SE Coastal Fl.– Owner Financing for a qualified buyer, Solo Dr., 2019 gross $688k, 6100sqft office and boarding space. New-Equine Practice– Brevard Co.-Rare opportunity to buy a turnkey Equine practice on the central east coast. 1 to 1.5 Dr. 2019 gross $670K. Barn, stalls, treatment area, paddocks, office Sold-Central Florida– North of Tampa– Well established, Solo Dr., $888K gross in 2019. In-house lab, digital x-ray, dental x-ray, 4400 sq., 3 exam rooms, Prx and RE available Sold-East Coast– Solo Dr. Prx with RE 2019 gross $1.07mm Very high net, well equipped, tenured staff. ~$270K in ADI. Sold-East Orlando– 1+ Dr. Practice, grossed $535K in 2019 Very nice lease space, 2 exam rooms, in-house lab, digital x-ray. Are Corporate Groups contacting you about buying your Practice? If so, let us help make sure you get your best deal!!!
LEON COUNTY: Long-established, small animal practice. $744K gross and $129K after-debt income in 2019. 1,978 SF facility with RE. Seller financing available! FL97 BROWARD COUNTY: Profitable, small animal practice. Over $1.2M gross and $206K after-debt income in 2019. 3,000 SF leased facility. Heavy traffic area! FL100 HARDEE COUNTY: Predominantly small animal practice expecting to gross over $1M this year! Gross up 27% year-to-date. $203K after-debt income in 2019. 2,400 SF facility with RE. Seller financing! FL101 BROWARD COUNTY: Start-up veterinary practice in a central, prime location! The renovated facility has brand new, top-notch equipment. Turnkey and ready for a doctor! 2,000 SF facility with RE. FL102
Contact Dr. Richard Alker for further practice information.
850.814.9962 or Richard@tpsgsales.com Showcase Properties of Central Florida, Broker
32 | FVMA ADVOCATE
psbroker.com | 800.636.4740 | firstname.lastname@example.org
CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED
VETERINARIAN WANTED – NAPLES, FL: Quality of life, quality of practice, what more could an associate want? Well, how about mentorship and teamwork? Gulfshore Animal Hospital has all of these to offer to the veterinary associate fortunate enough to join our practice. We have been a top ranking AAHA practice since 1996. Our clientele demands excellent veterinary care and, personalized professional service, and our team delivers. Learn all the skills you will ever need from the combined 70 years of experience of our 2 doctors. Enjoy the satisfaction and fulfillment that true team comradery can bestow in practice. Naples is ranked among the topmost desirable beach destinations in the US; a great place to visit, but an even better place to work and live. If this sounds like an inviting offer, it is! We can promise you that the visit alone to-our beautiful town will be well worth it. Experienced or new graduates are both welcome to apply. Salary includes base and production compensation which can easily exceed $100K in the first year. The fulltime position also includes an excellent benefits package and relocation expenses allowance. Future ownership opportunities available if desired. Please email your resume, along with your introductory letter explaining your goals and aspirations for your veterinary career to email@example.com. (5/20; ID#26066) VETERINARIAN WANTED – TAMPA, FL: Associate veterinarian needed, full or part time. 100% small animal, rapidly expanding, privately owned, non-corporate practice in a suburb of north Tampa. Two-yearold, very modern 10,000 s.f. facility, with full complement of modern equipment. Extremely flexible work hours, no emergencies, open to new vets as well as experienced practitioners. Opportunity to grow with our rapidly expanding practice. Extremely competitive pay and benefits package for the right candidate. Contact our office manager at Tammy@AcupetVetCare.com. (5/20; ID#27544) VETERINARIAN WANTED - ZEPHYRHILLS, FL: Veterinarian wanted in Zephyrhills, $200,000 annual salary. Please contact Dr. Adkins for more information at 407-529-5651. (5/20; ID#28095) VETERINARIAN WANTED – WEST PALM BEACH, FL: Enjoy practicing quality medicine in beautiful suburban West Palm Beach. Full Time Small Animal Associate Veterinarian position available in 3 DVM, AAHA Certified Hospital. Consideration given to enthusiastic individuals who practice progressive veterinary medicine and surgery, provide compassionate care and possess excellent client communication skills. Mentoring by Diplmate ABVP for new associates. State-of-theart equipment: Digital Radiology and Ultrasound, Luxar CO2 Surgical Laser, In-house lab, Endoscopy, Digital Dental Radiology. • Enjoy your time off o 4 day work week o 5 days off every 3 weeks • CE Allowance • Paid Time off • Paid Professional Association dues • 401k • Competitive Salary based on experience with ProSal bonus • DVM/VMD • Licensed in Florida Please email resume to firstname.lastname@example.org (5/20; ID#10351) PART-TIME EXPERIENCED VETERINARIAN FOR SUNNY FLORIDA PRACTICE – SPRING HILL, FL: How do we describe Advanced Pet Care in a word? GENUINE. An experienced veterinarian with a passion for creating lasting relationships with clients and patients would be an excellent fit at Advanced Pet Care. Our bustling companion animal clinic is ideally situated between Tampa and Orlando with plenty of recreational activities and state parks to enjoy. With it’s beautiful neighborhoods and plenty of Vitamin D, Spring Hill, Florida is the perfect place to drop roots. We celebrate the collaboration of great minds and support new ideas and integrations. We are dedicated to making sure our veterinarians, technicians and support staff are able to fulfill and advance themselves professionally and maintain a functional work-life balance. Having been a part of this community since 2012 but with over 50 years combined experience, the Advanced team is proud to make its mark, having built relationships spanning into the next generation. Our staff was hired based off of personality and their love for the patients. They are experienced, cross-trained, and work diligently to provide first class education and follow through to our clientele.
Become the best version of YOU in your veterinary career with Advanced Pet Care! Local State Park: https://youtu.be/RX1HK1-VUMc Candidates should: • SMILE! Afterall, you love your career, right? • Have a willingness to learn and grow professionally • Have a sense of humor • Be positive and energetic • Enjoy collaboration with colleagues, i.e. TEAMWORK! • Be an empathetic and competent communicator • Have a compassionate heart • Have an affinity for wellness and preventative care • Show proficiency in routine soft tissue surgeries and dentistry. Competitive salary based on skills and experience, health insurance, 401K with matching, license/dues/liability, vacation time and continued education allowance. Where: Advanced Pet Care Website: http://www.advancedpetcarespringhill.com/ Contact Kirsten Friedrichs at email@example.com or 630.712.0120. (5/20; ID#49029) FULL-TIME VETERINARIAN FOR PRACTICE IN CENTRAL FLORIDA – AVON PARK, FL: How do we describe Saunders Veterinary Services in a word? FAMILY. An enthusiastic veterinarian with a passion for practicing high quality medicine and creating lasting relationships with clients and patients would be a great fit at Saunders Veterinary Services. Our fully equipped, progressive companion animal clinic is situated within a culturally rich area making it the perfect location for a family or for anyone who enjoys the welcoming feel of a neighborly town. It’s no wonder Avon Park is known as The City of Charm. We offer mentorship and guidance from our outstanding team of veterinary colleagues. We celebrate the collaboration of great minds and support new ideas and integrations. This position is the perfect opportunity for a recent graduate who wants to start out on the right foot, or the seasoned veterinarian who wants independence when it comes to practicing medicine. We are dedicated to making sure our veterinarians, technicians and support staff are able to fulfill and advance themselves professionally and maintain a functional work-life balance. Having been a part of this community since 1985, the Saunders team is proud to be a community fixture, having built relationships that have spanned the generations. Our support staff was hired based off of personality and their love for the patients. The staff is experienced, cross-trained, and works diligently to provide first class education and follow through to our clientele. Become the best version of YOU in your veterinary career with Saunders Veterinary Services! Town Tour: https://youtu.be/SaKdAmhU6GU Candidates should: • SMILE! Afterall, you love your career, right? • Have a willingness to learn and grow professionally • Have a sense of humor • Be positive and energetic • Enjoy collaboration with colleagues, i.e. TEAMWORK! • Be an empathetic and competent communicator • Have a compassionate heart • Have an affinity for wellness and preventative care • Show proficiency in routine soft tissue surgeries and dentistry. Competitive salary based on skills and experience, health insurance, 401K with matching, license/dues/liability, vacation time and continued education allowance. Where: Saunders Veterinary Services Website: http://www.saundersvet.com/ Contact Kirsten Friedrichs at firstname.lastname@example.org or 630.712.0120. (5/20; ID#49029) VETERINARIAN WANTED – WINTER SPRINGS, FL: Tuscawilla Animal Hospital is seeking to add on an additional Veterinarian to our staff. We're located in Winter Springs (Orlando). Our 6,000 sq ft modern well equipped facility and well trained support staff allow us to
THE FVMA |
@FLORIDA_VMA | 33
practice exceptional veterinary medicine. Competitive salary offered with benefits that include CE/dues, paid vacation, medical insurance and 401 K. Please contact Tuscawilla Animal Hospital at 407-699-1500 or email at Tuscadvm@gmail.com.(5/20; ID#4346) VETERINARIAN WANTED - ALTAMONTE SPRINGS, FLORIDA 32701: PARTNERSHIP OPPORTUNITY. I am looking for young Veterinarian to inherit my busy and profitable small animal Practice located within the busy Altamonte Mall shopping center near Orlando. We have 3 exam rooms. Digital X-ray/Dental equipment/Well equipped treatment &Surgical suit. Gross earnings last 6yrs –$850,000 annually. You will pay your student debt with ease and live comfortably in Florida. Case load – 70% Vaccines, Heartworm testing & Sales of parasiticides. 20 % Internal medicine & Dermatology. 10% Soft tissue surgery. If you hate dull moments and love challenges, this is a great opportunity for you. Contact Dr. Kuria by phone or text - 310 -936-3005 or email -email@example.com. (5/20; ID#19693) VETERINARIAN WANTED – BOYNTON BEACH, FL: Colonial Gateway Veterinary Center, a 4500 square foot facility and its sister-hospital, Colonial Animal Hospital have been servicing the Boynton Beach and Tri-County area for over thirty years. There is a strong family feel to our practices; we hope never to outgrow that. We are seeking full and part time, high-energy veterinarians who are intent on building a practice and professional reputation through always ethical, progressive, wellnessfocused medicine, and strong client relationships. The best-fit candidate is excited to “make-a-difference” with the team s/he works, the patients s/ he cares for and clients s/he services. We offer a full range of dental, soft tissue and orthopedic surgical services, both hospitals house advanced diagnostic equipment, including a new ultrasound, digital and laser technology, a complete in-house laboratory, relationships with reference laboratories, local board certified specialists and emergency facilities. Our two East Boynton Beach locations are close to beautiful beaches, Miami/Dade, Broward, and Palm Beach County downtown areas, cultural and wildlife centers. Our area offers a great and diversified lifestyle. SIGN-ON BONUS AND PAID RELOCATION EXPENSES OFFERED Please email your CV to Colonial1gateway2@gmail.com. All CVs are received in confidence. -practice preventive/wellness and progressive medicine – strong interest in surgery – are an innate mentor and teacher – enjoy building relationships with clients – emphasis on continuing education NOTES: Additional Salary Information: Our compensation package, commensurate with experience includes a fixed annual salary and bonus program with exciting earning potential, medical and professional benefits, CE allowance, a matched pre-tax savings program, paid, personal, sick and vacation tine, Association dues, licensing fees, flexible scheduling and a pleasant work environment. Please contact Lisa Martin for more information at (561) 317-5304 or by email at firstname.lastname@example.org.(5/20; ID#28745) VETERINARIAN WANTED - GREER, SC.: $$25,000 sign on bonus$$ $$ SIX FIGURE $$ Compensation in 3 doctor, small animal practice with flexibility in setting your schedule and a practice owner that champions mentoring and growth. Full time Veterinarian needed at West Spartan County Animal Hospital with caring, well trained staff to work with and assist you. New Grads welcome! West Spartan County Animal Hospital is a 3 doctor, exclusively small animal practice. We have been at this location since 1982. At West Spartan County Animal Hospital, we offer a fully equipped in house lab, radiography, ultrasound, endoscopy, and surgery center. Benefits include salary that exceeds 15% above the average industry standards, retirement and memberships. Along the way, we know you’ll build a loyal client base and we’ll help you sharpen your edge through continuing education. Greer is in the heart of Upstate South Carolina at the center of the Greenville-Spartanburg area. Home to the BMW plant, the only U.S. manufacturing facility. With access to plenty of amenities, you can head out to the Blue Ridge Mountains or the sandy beaches of South Carolina Coast. Greer has a small town personality with big city amenities! West Spartan County Animal Hospital Address: 13220 E Wade Hampton Blvd, Greer, SC 29651 For more information please contact Kaley at 229-347-1410. (5/20; ID#49160)
34 | FVMA ADVOCATE
VETERINARIAN WANTED - BAINBRIDGE, GA.: $$25,000 sign on bonus$$ $$ SIX FIGURE $$ Compensation in two doctor, small animal practice with flexibility in setting your schedule and a practice owner that champions mentoring and growth. New grads welcome! Full time Associate Veterinarian needed at Bryan-Hight Veterinary Hospital in Bainbridge, GA with caring, well trained staff to work with and assist you. New Grads welcome! Bryan-Hight Veterinary Hospital is a 2 doctor, exclusively small animal practice. We have been at this location since 1968. At Bryan-Hight Veterinary Hospital, we offer a fully equipped in house lab, digital radiography and surgery center. Benefits include salary that exceeds 15% above the average industry standards, retirement and memberships. Along the way, we know you’ll build a loyal client base and we’ll help you sharpen your edge through continuing education. Bainbridge, GA is located in the southwest corner of Georgia, surrounded by the serenity of nature, filled with excitement and history and home to true southern hospitality. Bainbridge is located in the center of large quail plantations. Also, Bainbridge, GA is only 2 hours away from one of the most popular beaches in Florida. Also, just 41 miles from Tallahassee, the capital of Florida, is the largest city in the state's Panhandle region. A center for shopping & entertainment, Tallahassee boasts a vibrant college community that includes Florida State University, Florida A&M and several smaller schools. Tallahassee is also known for its parks and gardens. 1801 E Shotwell St, Bainbridge, GA Bryanhightvet.com For more information please contact Dr. Steven Whatley at 229-3471410. (5/20; ID#49160) VETERINARIAN WANTED - STEVENSON, AL.: $$25,000 sign on bonus$$ $$ SIX FIGURE $$ Compensation in two doctor, small animal practice with flexibility in setting your schedule and a practice owner that champions mentoring and growth. New grads welcome! Full time Associate Veterinarian needed at North Jackson Animal Clinic with caring, well trained staff to work with and assist you. New Grads welcome! North Jackson Animal Clinic is a 2 doctor, exclusively small animal practice. We offer a fully equipped in house lab, digital radiography and surgery center. Benefits include salary that exceeds 15% above the average industry standards, retirement and memberships. Along the way, we know you’ll build a loyal client base and we’ll help you sharpen your edge through continuing education. Dr. Steven Whatley Owner For more information please contact Dr. Steven Whatley at 229-3471410. (5/20; ID#49160)
RELIEF VETERINARIAN: "Got to get away? "VetRxRelief , 37 years experience small animal Veterinarian. Please call 321-508-3879 or Vetgator@gmail.com. (5/20; ID #2187) RELIEF VETERINARIAN – FORT MYERS, FL: Available for relief coverage in Fort Myers area. Over 10 years experience. Able to provide medical, surgical and emergency coverage. Contact Smith Veterinary Relief Service at (802) 591-0372 or email@example.com. Website: www.smithveterinaryrelief.com.(5/20; ID #38982)
EQUIPMENT FOR SALE
EQUIPMENT FOR SALE – DELTONA, FL: Cutting Edge Surgical Laser with Evacuation System for sale, $15,000.00; local pickup only. If you would like to see the full listing, please follow the link to our Ebay listing https://ebay.us/eqIfA5. If you have any questions, please call (386) 532-0999. (5/20; ID#8807)
PRACTICE FOR SALE
PRACTICE FOR SALE - MELBOURNE, FL: Turn Key, fully equipped hospital , Space Coast, close to beach, marina, and shopping. Equipment also for sale separately. Call 321-508-3879 or VetGator@gmail.com. (5/20; ID#2187) PRACTICE FOR SALE – ZEPHYRHILLS, FL: 50-year-old practice for sale. Seller financing 80% of the appraised value of the practice and equipment. For more information please contact Dr. Larry Adkins at (407) 529-5651. (5/20; ID#28095)
Are you One of thousands...
...or the One that matters?
PRACTICE SALES FREE VALUATIONS ASSOCIATE BUY-INS CORPORATE SALES BUYER REPRESENTATION
FLORIDA LISTINGS JUST LISTED! MIAMI GROSSING OVER $1MILLION! NEAR BUSY PARKWAY LEASED FACILITY
REBECCA ROBINSON DAVIS, CBI BRENNAN MCGOLDRICK, DVM, MBA
CENTRAL FLORIDA GROSSING OVER $700K! $50K UPGRADE ALLOTMENT ATTACHED LIVING QUARTERS
*See National Listings @ practicesalesadvisors.com
912.268.2701 | HELLO@PRACTICESALESADVISORS.COM WWW.PRACTICESALESADVISORS.COM
Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809
PRSRT STD U.S. Postage PAID Orlando, FL Permit #793
WHEN IT COMES TO SELLING YOUR PRACTICE, GETTING THE BEST PRICE IS JUST THE FIRST STEP. PROTECTING YOUR LEGACY SHOULD GUIDE THE JOURNEY. Your practice is worth more than just a building with equipment. Its value includes your dedicated team, carefully crafted culture, and personal commitment to pets and their families. That is why we approach selling your practice with the goal of ensuring you receive a maximum return and that your legacy continues. Whether youâ&#x20AC;&#x2122;re considering a private or corporate sale, partner with the experts to navigate the process.
42 Years | 3,200 Sales Transactions | 12,000 Practices Appraised
Call us today at 800.333.1984 for a complimentary and confidential conversation.
Learn more at simmonsinc.com