FVMA Advocate Issue 5 2019

F V M A ADVOCATE ISSUE 5 | 2018

THE STATE OF FARM ANIMAL VETERINARY MEDICINE IN FLORIDA ~ Page 7 SAFETY IN ANESTHESIA FOR SENIOR PETS SERIES: PART 2 ~ Page 12 YOUR INVITATION TO ATTEND 56TH ANNUAL OCALA EQUINE CONFERENCE ~ Page 14

President's MESSAGE “'Tis not in numbers but in unity that our great strength lies” - Thomas Paine 7207 Monetary Drive Orlando, Florida 32809 Phone – 407.851.3862 Toll Free – 800.992.3862 Fax – 407.240.3710 info@fvma.org | www.fvma.org

OFFICERS

Dr. Marc A. Presnell President Dr. Michael Epperson President-elect Dr. Donald H. Morgan Treasurer Dr. Alex M. Steverson Past President Mr. Philip J. Hinkle Executive Director

DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Todd Fulton District 3–Central Dr. Rachel Klemawesch District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Marta P. Lista District 6–South Florida Dr. Mary Smart District 7–Southwest Dr. James M. Brechin District 8–Northwest Dr. Kelly J. Sloan-Wade 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 Ex Officio Dr. James W. Lloyd, Dean UF College of Veterinary Medicine

These past few months have flown by and have been filled with challenges and opportunity. In 2017, Hurricane Irma cut a path of destruction from the Florida Keys, through West Central Florida and then into Georgia. This year, Hurricane Michael carved its path through the Florida Panhandle leaving many of our colleagues facing crushing challenges. It is times like these that remind us of our mutuality, our oneness in this mission of serving the animals and the public of Florida, and our need for one another. Dr. Terry Clekis, the FVMA’s Disaster Response Committee chair, has again spearheaded the FVMA’s efforts to support the animals and the practitioners affected by the storm. Thank you to all who have offered your services, supplies, finances and moral support, even offering homes and practice space to those in need. Contact the FVMA office for more information on available post-disaster resources or to contribute to the FVMA Foundation to assist the victims of the storm. Together, we can get through these challenges.

In September, the FVMA met to review the Strategic Plan of the FVMA for 2020-2025 and to create a strategic plan for the FVMA Foundation. Our mission continues to be to advance the veterinary medical profession, promote animal health and well-being, and protect public health. In order to more effectively fulfill this mission, the FVMA will continue to enhance our working relationship with the Florida Association of Equine Practitioners (FAEP), the UF College of Veterinary Medicine (UF CVM) and the new team member associations. We are also developing strategies to better serve all fields of veterinary medicine including food animal, shelter medicine, exotic animal and wildlife medicine. Currently representing 4,200 veterinarians and more than 1,600 veterinary team members, the FVMA wants 100 percent of our profession to join because together, as one voice, we will more effectively advance the profession and meet the needs of the animals of Florida. Do you know someone who is not a member of the FVMA? Encourage them to join today.

Speaking of sticking together – did you know that this year Kentucky passed a 6 percent services tax on all veterinary companion animal service which went into effect on July 1? Even after the governor vetoed the bill, the legislature voted to overturn the governor’s veto. Did you know the FVMA Professional Advocacy Committee (FVMA PAC) has helped to defeat a similar bill in Florida? Did you know the Florida state legislature is still looking for ways to increase revenues? The FVMA, already recognized by our legislators as the voice of veterinary medicine in Florida, is advocating on behalf of the animals of Florida so that animals are not prevented from receiving the care they need due to similar increases in the cost of care. Have you donated to the FVMA PAC this year? Give now to help us amplify your voice for the animals of Florida!

Lastly, the FVMA is continuing to provide outstanding continuing educations opportunities. The FAEP’s 14th Annual Promoting Excellence Symposium (PES) just concluded its world-class presentation of equine-exclusive continuing education. The 6th Annual Gulf-Atlantic Veterinary Conference (TGAVC) was held in early December and was once again a record-breaking meeting! The Ocala Equine Conference and the Harvey Rubin Memorial Food Animal Conference are not far behind. Lastly, the launch of the Power of 10 Leadership Training Program is just around the corner. Start preparing now to nominate and support the next generation of leaders of veterinary medicine in Florida so that together we can continue to advance the profession of veterinary medicine in Florida.

Respectfully,

Marc Presnell, DVM

FVMA MISSION THE MISSION OF THE FLORIDA VETERINARY MEDICAL ASSOCIATION IS TO ADVANCE THE VETERINARY MEDICAL PROFESSION, PROMOTE ANIMAL HEALTH AND WELL-BEING, AND PROTECT PUBLIC HEALTH. 2 | FVMA ADVOCATE

In Remembrance Dr. Gregory Lee Winters Long-time FVMA member Dr. Gregory Winters passed away at the age of 84 on October 26, 2018, having served the Florida veterinary community for more than 50 years. He received his veterinary medicine degree from the School of Veterinary Medicine at the University of Georgia. Upon graduation, he joined the U.S. Air Force serving as a base veterinarian at MacDill Air Force Base in Tampa, Florida.

Dr. Winters opened Pine Hills Veterinary Clinic in Orlando, Florida in 1961, and later built the Animal Clinic of Windermere in 1986. He worked actively as a veterinarian in the Central Florida community until he retired in July 2000. He was a FVMA member since 1961 and was also a member of the American

Veterinary Medical Association (AVMA). He was a past president of the Central Florida Veterinary Medical Association.

When not helping animals, Dr. Winters loved to play tennis, along with water-skiing and scuba diving.

He loved to travel, and he took many scuba diving trips in places such as Central America, Mexico and The Keys. He also visited most of the U.S., many parts of Europe, areas of South America and Africa.

Dr. David Guitar FAEP/FVMA member Dr. David Guitar passed away at the age of 72 on September 19, 2018, having served the equine community throughout the U.S. for more than 40 years. He received his Doctorate of Veterinary Medicine from Texas A&M University, and he also received a Ph.D. from Baylor College of Medicine in Houston. After working as an associate veterinarian at two prior practices upon graduation, Dr. Guitar started Stafford Oaks Veterinary Hospital in Stafford Oaks, Texas where he was the owner and an active practitioner from 1973 to 1998.

Over the years, Dr. Guitar’s career took him all over the U.S. In 1998, he founded Guitar Veterinary Services on his ranch in Merkel, Texas where he primarily focused on equine sports medicine and reproduction.

He was an active member in many organizations, including the Florida Association of Equine Practitioners, American Association of Equine Practitioners, Texas Veterinary Medical Association, Texas Equine Veterinary Association, American Quarter Horse Association, National Cutting Horse Association, American Cutting Horse Association, and Texas & Southwestern Cattle Raisers Association. He had attended FAEP’s Promoting Excellence Symposium (PES) and Ocala Equine Conference (OEC) multiple times in the past.

Dr. Thomas "Doc" Monfort Dr. Thomas “Doc” Monfort passed away on October 18, 2018, at the age of 79 at his home in Farm City, Illinois. He received his DVM degree in 1963 from Purdue University's College of Veterinary Medicine.

offered to include reproduction and lameness specialists. He was a FVMA and FAEP member since February 2011.

In 1971, he opened the Illinois Equine Center, where he continued to work as an equine veterinarian until retirement. Upon retiring, his practice and legacy continues under the new name of Midwest Equine, continuing to provide equine veterinary services throughout Central Illinois while expanding its services

Dr. Monfort was very well-known and respected in the Illinois equine community and served it for decades.

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In This Issue

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3 | In Remembrance

Dr. Harvey Rubin

5 | Member Spotlights 7 | The State of Farm Animal Veterinary Medicine in Florida 10 | 2019 FVMA Awards Nominations Now Open 12 | Safety in Anesthesia for Senior Pets Series: Part 2 14 | Ocala Equine Conference 2019 24 | Practice Pulse 28 | Classified Advertisements

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MEMBER SPOTLIGHTS FVMA MEMBER RECEIVES AAHA DEDICATED SERVICE AWARD Longtime FVMA member Link Welborn, DVM, DABVP, CCRT, was awarded the first AAHA Dedicated Service Award by the American Animal Hospital Association (AAHA) in September 2018. The award is presented to a veterinarian who is an AAHA member involved in or retired from clinical private or academic practice. They must have at least 20 years of commitment and service to AAHA, the veterinary profession, the community they serve and their patients. Dr. Welborn, who is an AAHA past president, was the first individual to receive this award due to his excellence in small animal medicine for more than 25 years.

“I’m honored and humbled to receive the first AAHA Dedicated Service Award,” Dr. Welborn said. “It has been an amazing privilege to work with so many gifted leaders with the common

goal of making the most wonderful profession in the world just a little better.”

Dr. Welborn has been involved with AAHA for many years, having been a member of the AAHA Canine Vaccination Guidelines Task Force since its inception in 2002 and has served as chair since 2010. He has also been very involved in the AVMA, serving as a member and past chair of the AVMA Veterinary Economics Strategy Committee. He also currently serves as chair of the AVMA Practice Finance Research Group.

He has also been acknowledged for his involvement, hard work and dedication to the profession over the years, receiving numerous honors and awards. Dr. Welborn has been awarded the FVMA Veterinarian of the Year Award in 2005, the AVMA President’s Award, AAHA Practitioner of the Year Award and University of Florida College of Veterinary Medicine (UF CVM) Alumni Achievement Award.

In addition to receiving FVMA’s Veterinarian of the Year Award, he was also a volunteer for the former FVMA College Advisory Committee to promote cooperation between the FVMA and the UF CVM through various programs. He was on this committee from 1996 to 2013.

FVMA MEMBER-OWNED ANIMAL HOSPITAL RECEIVES AAHA ACCREDITATION Island Animal Hospital received American Animal Hospital Association (AAHA) accreditation for all of its three locations in Brevard County, making it a part of only 15 percent of animal hospitals in the U.S. and Canada to earn this highest level of veterinary excellence and achievement. Each location had a thorough evaluation by AAHA, where the hospital’s protocols, medical equipment, and facility and client service were reviewed.

Island Animal Hospital is owned by FVMA members Drs. Matthew and Erin Coris, and it’s a full-service veterinary medical practice that includes, but isn’t limited to, services like medical care, boarding, grooming and dental care for all types of pets.

Island Animal Hospital has three locations: one in Merritt Island, Viera and Cocoa Beach.

"Undergoing accreditation can be a long process, but in the end we felt we owed it to our clients to provide the highest level of care," Dr. Matthew Coris said.

Animal hospitals are not required to receive accreditation, unlike human hospitals, so practices that receive AHAA accreditation are expected to be at the forefront of advanced veterinary

Dr. Erin Coris

Dr. Matthew Coris

medicine and clients can expect the highest quality care. There are around 900 quality standards that animal hospitals must meet to be AHAA accredited that include everything from patient care to staff training, and these standards are constantly being reviewed and updated. Because they’re constantly updated, Island Animal Hospital will have to be regularly evaluated to maintain its accreditation status.

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The State of Farm Animal Veterinary Medicine in Florida

By Samantha Rosenthal, FVMA Communications

Photo courtesy of Jesse Jones

From the meats to eggs on the shelves at your local grocery store, many individuals know the role producers play in getting those products there — what they don’t realize is the critical role that veterinarians play in the steps along the way to getting that product to the consumer. When the public thinks of veterinarians, an image of an individual in a white coat in an office setting is usually what comes to mind. Many don’t realize there’s a whole area of veterinary medicine focused on large animals, specifically farm/food animals.

Large animal veterinary medicine focuses on managing the health and welfare of livestock animals, which can include horses, cattle, sheep and even bees. A large part of large animal veterinary medicine deals with what’s called farm animal veterinary medicine (FAVM), which is also sometimes referred to as food animal veterinary medicine. These practitioners learn a very specific skills set that allows for them not only to care for the health and well-being of these animals, but to also ensure that the products from these animals, like dairy and meat products, are safe once it reaches consumers.

Dr. Owen Rae, chief of the UF College of Veterinary Medicine’s food animal reproduction and medicine service, and Dr. Katelyn Menacho, then a fourth-year UF veterinary student, greet a young Brahman steer at the UF/IFAS Beef Teaching Unit in Gainesville in 2017.

“If we look at a food animal product such as a steak or an egg in the supermarket, veterinarians are involved in a lot of different steps along the way from before the time the animal is conceived until after the product is harvested from that animal,” says Dr. Fiona Maunsell, who is a clinical assistant professor for UF CVM's Food Animal Reproduction & Medicine Services.

“If somebody has a cow that is having trouble giving birth, we would provide assistance to that cow. If there’s a sick calf, we would provide treatment for that calf — all the way up to providing herd-level health programs for very large populations of animals and making sure those are implemented properly,” Dr. Maunsell explains.

Food animal practitioners have a few main areas of focus when it comes to the role they play for the consumers’ food supply. They help the farm be productive, for example ensuring that dairy cows are healthy so that they can produce milk. These practitioners also have an important role in food safety, making sure that the products coming from those producers and going into the food chain are safe to consume. These veterinarians are also in charge of the health, well-being and welfare of the animals themselves, making sure they’re cared for. The FVMA talked to some of its veterinarian members who practice and teach FAVM, providing some insight into the important role these practitioners play.

According to the Florida Department of Agriculture and Consumer Services (FDACS) website, Florida had 47,000 commercial farms and ranches, using a total of 9.45 million acres in 2017, ranking 18th among all states in number of farms. The Division of Animal Industry within the FDACS is responsible for enforcing animal health regulations in Florida and protecting the state from animal pests and diseases. Veterinarians assume roles along the food chain that help at every step. This can include implementing preventative health measures like vaccination programs that properly allow for the use of antimicrobials on that farm for a treatment of specific diseases, or overseeing how and where those antimicrobials are used to make sure people are trained to use them properly.

Farm Animal Veterinary Medicine (FAVM) & the Role Veterinarians Play

Much like small animal veterinarians, a day for a farm animal practitioner can consist of routine health exams, vaccinations, ultrasounds and performing other duties any other veterinarian would perform. These practitioners, though, also have the duty of performing other tasks, like monitoring and assisting with the reproductive health of livestock.

“The rural veterinarian usually has to practice medicine on a wide variety of animals,” says Florida State Veterinarian and Division Director of Animal Industry Dr. Michael Short. “You would often have your routine health program maintenance with the producer, making sure the animals are healthy and vaccinated properly. If they have any minor issues health-wise, like a respiratory health issue going through the herd, we would help them address that.

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Photo courtesy of Nick Burchell

to quality assurance of the food supply, includes keeping diseases that are dangerous to people out of the food products that we eat and making sure that injections such as vaccinations are performed correctly to assure a high quality of meat from that animal.

Dr. Fiona Maunsell, a clinical assistant professor with the UF College of Veterinary Medicine’s food animal reproduction and medicine service, (right), and Dr. Meredith Montgomery, then a fourth-year UF veterinary student, review information on milking machine function at the UF/IFAS Dairy Unit in Hague.

Among your routine health management programs, you’re often seeing a wide variety of emergencies where the animal needs to be seen that day, if not within that hour, to make sure they’re taken care of.”

Across the country, college of veterinary medicine programs focus on different disciplines based on what the agricultural needs are for that region. In Florida, subtropical beef cattle production and dairy production medicine are strong staples taught at the University of Florida College of Veterinary Medicine’s Food Animal Reproduction and Medicine Service (FARMS) program and the most commonly practiced farm animal veterinary medicine service throughout the state. As of January 1, 2018, all cattle and calves on Florida farms and ranches, including dairy cattle, totaled 1.63 million head. Of that total, 886,000 are beef cattle. Nationally, Florida is ranked 13th in the nation for beef cattle.

In addition to the role these veterinarians play in taking care of the animals on farms and in rural areas, these individuals also take on an even more important overarching role: ensuring the health and safety of the millions of individuals who consume this food supply.

Dr. Short says that another public health issue regarding FAVM is antibiotic resistance and trying to keep up with the current regulations. Just like human medicine, there’s been a lot of discussion on antibiotic resistance in veterinary medicine, and it’s becoming more of an issue of concern worldwide. There’s more regulation, as well as discussions, on how veterinarians can help producers manage their herds better and practice better husbandry so that antibiotics don’t have to be used. Dr. Short says farm animal veterinarians are a big part of the solution of decreasing and stopping antibiotic resistance.

Outside of a field setting, many veterinarians are also involved in food safety research, zoonotic disease research and epidemiological studies with government agencies (i.e. CDC).

They help make sure, by using the most accurate and seamless techniques and routines, that things like withdrawal and holding periods for livestock are done properly so the meats, milk or eggs you pick up at the supermarket are harvested from that animal properly and safely for both the consumer and the animal.

Keeping the Animal Well-being First

Dr. Short explains that when it comes to farm animal veterinary medicine, it is truly a holistic approach to medicine. There has become a renewed focus due to the One Health Initiative on the partnership of all entities involved in the areas of the environment, human health and animal health. Veterinarians are playing a more active role and are now, more than ever, focused on all the facets of animal health and well-being.

“I think more and more veterinarians and producers are having to deal with – and I think it’s a good thing to think about – just the animal welfare issue, making sure we’re taking care of animals

FAVM and Public Health Issues

A wholesome food supply, along with a healthy animal, is a large part of the responsibilities of farm animal practitioners. Dr. Maunsell explains that the role of veterinarians, when it comes

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Photo courtesy of Nick Burchell

“I think food animal practice is really just a down-to-earth way that you, as veterinarian, can work with the producer, as your client, and help them be productive and take good care of their animals. You have a sense of comfort that you are helping assure that the food supply going to the consuming public is wholesome and healthy,” says Dr. D. Owen Rae, who is a professor and the service chief for UF CVM's Food Animal Reproduction & Medicine Services.

Dr. Maunsell reviews the day’s treatment schedule at the UF/IFAS Dairy Unit in Hague.

veterinarians entering the profession who want to work in FAVM.

Photo courtesy of Jesse Jones

“The major change over time is the urbanization of the population,” Dr. Rae says. “We only have 2 percent of the population that provides food for the other 98 percent of the U.S., so the majority of students are coming from urban populations now. I grew up with my grandfather’s ranch three miles away, but I still had to go there to be involved in it. Now we have a population that doesn’t have a grandfather that they can go to their farm or ranch. Kids grow up without the knowledge of farm life and the experience of large animals.”

Brahman cattle gather to greet visitors at the UF/IFAS Beef Teaching Unit in Gainesville in 2017. like we should and giving them the treatment and respect they deserve,” says. Dr. Short.

Drs. Maunsell, Rae and Short all agreed that animal welfare and well-being is the No. 1 priority when it comes to practicing FAVM, allowing that mantra to guide them in their everyday work.

Oftentimes, veterinarians, and the producers they help, must deal with criticism from the public and outside organizations about the work they do. This ranges from consumers thoughts on how the food supply is managed to how animals are treated and cared for on farms.

“A misconception is that producers just treat all their animals like numbers and that they don’t have that individual connection to their animals, but that’s really not true at all,” Dr. Maunsell says.

“Most farmers have a really strong connection with their animals.

They really care about them and doing the right thing by them.”

Even though these animals might have an end in providing nutrition for humans, it’s important that they’re taken care of and have the best life possible for the time they’re growing.

The Future of FAVM

Over the last decade, food animal veterinary medicine has become more technical, and research has helped reveal more of the science behind it. Along with the advancement of technology, this has allowed for practitioners to do more in the field and has become encouraging for the future of FAVM. “We have definitely had lots of changes in equipment and tools available to us,” Dr. Rae says. “The basic veterinary knowledge and application of veterinary examination has not changed but our knowledge of disease and knowledge of hygiene has certainly grown, and our techniques and tools to identify disease problems and examine them has increased dramatically.”

At veterinary schools, there are programs and clubs that have been started to increase awareness and interest in this field of veterinary medicine. At UF CVM, a food animal club was started by students, and is supported by faculty mentors. This club has assisted in putting together wet labs to help veterinary students, including first-year students, become exposed and experience this type of veterinary medicine early. UF CVM also offers an official certificate in food animal veterinary medicine, which students can receive upon graduation after taking elective food animal courses and acquiring additional hands-on experience.

They can show the certificate to a prospective employer, which demonstrates their targeted effort to become a food animal practitioner.

On a national level, organizations like the American Association of Bovine Practitioners have increased its efforts to assist students from veterinary schools to participate in the national organization and to support students going to externships. The organization has funds available, so there is money available through scholarships and funds to support and encourage students to participate – hoping in the end it helps spark their interest.

Dr. Short says that students often mention things like location, pay, hours or lifestyle that deters them from entering into this particular field of veterinary medicine. Initiatives, like the ones mentioned, are being put in place to try and incentivize veterinarians – whether it be students or seasoned veterinarians – to go into those underserved areas.

“A lot of food animal veterinarians love what they do because they get to be outside all day long. They get to work with great really down-to-earth people,” says Dr. Maunsell. “The other thing is that you have the possibility of making a really big impact on both the farmer and his bottom dollar, but also on the lives of really big populations of animals. Instead of treating one animal, you have the opportunity to make a really big impact on the lives of sometimes thousands of animals at one time, so that can be really exciting as well.”

Another trend within the field of FAVM is the increased effort to encourage more incoming students to work in this area of veterinary medicine, as there has been a decline in the number of

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NOMINA T

CAL L

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Nominations Deadline

FOR THE 2019 FVMA ANNUAL AWARDS FVMA SERVICE AWARDS NOMINATIONS DEADLINE IS FEBRUARY 1, 2019

Nominations now open for the 2019 FVMA Annual Awards The Florida Veterinary Medical Association invites you to nominate deserving candidates for the 2019 FVMA Annual Awards!

Awards in several categories will be determined by a special committee in early February 2019. Award recipients will be publicly honored at an awards presentation ceremony on May 17, 2019, during the 90th FVMA Annual Conference in Tampa, Florida.

This is an important program for our Association, giving us as a family, the opportunity to honor outstanding members and individuals who serve our profession with distinction and contribute to the advancement of veterinary medicine in the state of Florida. We invite you to participate in this valuable program to recognize peers, colleagues and friends of the profession for their achievements and contributions.

The Annual Awards also highlight exceptional service by Florida citizens who have dedicated their time, talent and services to the enhancement and protection of the veterinary profession.

Awards include a “Citizen of the Year,” and nominated pets can be inducted into the “Pet Hall of Fame” with a Pet Hero Award.

Nomination forms and listings of past award recipients are available at www.fvma.org. Members of the FVMA are encouraged to nominate deserving colleagues and friends of veterinary medicine for an award.

Members may also call the FVMA toll-free at 800.992.3862 for assistance in nominating a deserving colleague or friend for an award.

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Thank you for answering the call to honor our exemplary veterinary medical professionals and those friends of the profession who contribute so much to promote animal health and well-being.

2019 Award Categories • • • • • • • •

Distinguished Service Veterinarian of the Year Lifetime Achievement Gold Star CVT of the Year Team Member of the Year Citizen of the Year Pet Hero

Submit Your Nominations by

February 1, 2019

SERVICE AWARD CATEGORIES & ELIGIBILITY CRITERIA DISTINGUISHED SERVICE AWARD

• LEADERSHIP – Assumes a leadership role in creating and maintaining an efficient and highly motivated animal health care services delivery team among all employees.

• EDUCATION – Regularly strives to further develop his/ her knowledge and skills by participating in continuing education seminar; formal study at a junior college or university; or by undertaking self-directed study through journals, online programs, etc.

The Distinguished Service Award is awarded for exceptional achievements and contributions by a member toward the advancement of veterinary medicine and the profession. To qualify, a member must have been dedicated to veterinary medicine and given time and energy beyond reasonable expectations. To be eligible for this award, a nominee must have been an active member of the Association for at least the past 15 years.

VETERINARIAN OF THE YEAR AWARD

The Veterinarian of the Year Award is awarded to a member for distinguished, unselfish and dedicated service to the Association for the advancement of veterinary medicine and the profession.

To be eligible for this award, a nominee must have been an active member of the Association for at least the past 10 years.

LIFETIME ACHIEVEMENT AWARD

The Lifetime Achievement Award is awarded to senior active and retired members who have made outstanding contributions to the Association and veterinary medicine. To be eligible for this award, a nominee must have been an active or retired member of the Association for the last 30 consecutive years and must be at least 65 years old. In exceptional cases, the service requirement may be reduced to 25 years.

CITIZEN OF THE YEAR

Citizen of the Year is awarded to any non-veterinarian who has made an outstanding contribution to the advancement of the Association and veterinary medicine.

PET HALL OF FAME

One inductee to the Pet Hall Of Fame will be selected for one of the following categories.

1. HERO – Pets who have unselfishly saved or preserved human life (non-professional).

2. COMPANION – Pets who have provided a benefit and contributed to the quality of life of their human companions.

3. PROFESSIONAL – Specialty trained as a physically challenged person’s assistance animal or used in law enforcement.

TEAM MEMBER OF THE YEAR

GOLD STAR AWARD

The Gold Star Award is awarded to members who have contributed much of their time and energy to the Association and/or a local association for the advancement of veterinary medicine and the profession. To be eligible for this award, the nominee must have been an active member of the Association for at least the past three years.

CERTIFIED VETERINARY TECHNICIAN OF THE YEAR

This award recognizes the many outstanding contributions made

by Certified Veterinary Technicians (CVT) to the overall success of the veterinary practice operated or staffed by an FVMA member veterinarian. To be eligible for nomination of this award, the individual must be a full-time employee of an FVMA member practice for a minimum of three years and demonstrate the following: • CARING – Provides animal health care services in a compassionate and clinically appropriate manner.

• COMMITMENT – Works in support of the employing veterinarian to achieve a high level of client satisfaction and established annual performance goals of the veterinary practice.

This award recognizes the many outstanding contributions made by Team Members to the overall success of the veterinary practice operated or staffed by an FVMA member veterinarian.

To be eligible for nomination for this award, the individual must be a full-time employee of an FVMA member practice for a minimum of three years and demonstrate the following: • CARING – Provides animal health care services in a compassionate and clinically appropriate manner.

• COMMITMENT – Works in support of the employing veterinarian to achieve a high level of client satisfaction and established annual performance goals of the veterinarypractice.

• LEADERSHIP – Assumes a leadership role in creating and maintaining an efficient and highly motivated animal health care services delivery team among all employees • EDUCATION – Regularly strives to further develop his/her knowledge and skills by participating in continuing education seminar; formal study at a junior college or university; or by undertaking self-directed study through journals, online programs, etc.

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SAFETY IN ANESTHESIA FOR SENIOR PETS SERIES: PART 2 RALPH HARVEY | DVM, MS, DACVAA In the first of this three-part series, we examined the physiological changes associated with aging and what should be considered when using anesthesia on these patients. The second part of the series will address the pharmacology, as it is very important to note what to consider regarding anesthetic and preanesthetic drugs in the geriatric patient.

PHARMACOLOGY

The most important age-related changes in the distribution of anesthetic and preanesthetic drugs in the geriatric patient are in the disposition (partitioning within the various distribution volumes) and clearance (excretion, metabolism or conjugation of drugs). The geriatric patient often may have decreased plasma protein binding capabilities, decreased total body water, hepatic dysfunction and an increase in the total body lipid into which the anesthetics are ultimately distributed. The slight reduction in plasma albumin concentrations in aged patients is most likely not sufficient to produce clinically important changes in the amount of active or unbound drug in plasma after intravenous (IV) drug administration. The aging processes probably do not substantially alter the parenteral uptake of drugs.

The physical characteristics of drug molecules make them either lipophilic or hydrophilic; thus, it determines their ultimate partitioning between lipid tissues (brain, adipose tissue and viscera) and aqueous body compartments (blood, extracellular fluid and skeletal muscle). As a patient ages, there is a progressive decrease in the absolute volume of the aqueous fraction and an increase in the lipid compartments. Therefore for hydrophilic drugs, the decrease in the aqueous fraction of the body of an aged patient could produce higher than expected initial plasma levels after IV administration of recommended doses even when the dose has been adjusted for total body weight. The typical net pharmacokinetic effect is an increase in effective drug concentration, and the net pharmacodynamic effect is an enhancement of drug potency.

Because lipophilic drugs undergo some initial distribution to highly perfused nonadipose lipid tissues, the effects of the decreased aqueous fraction of the body is offset. However, because of the significant increase in total body lipid into which lipophilic drug molecules are ultimately distributed, the elimination process is markedly delayed in the geriatric patient. Age also alters drug disposition or pharmacokinetics by significantly reducing both renal and hepatic function, thus decreasing the clearance of drugs eliminated through these pathways regardless of whether a drug is lipophilic or hydrophilic.3 Pharmacodynamics, or the relationship between drug quantity and drug effect, is frequently altered in the geriatric patient. | FVMA ADVOCATE 12 | 12 FVMA ADVOCATE

Geriatric patients have decreased circulating blood volume, or decreased volume of the central compartment, which can produce high initial plasma concentrations of anesthetic drugs.

However, the many observations of the need for reduced doses of anesthetic agents in geriatric patients cannot be explained by this pharmacokinetic effect. Human studies involving tranquilizer and sedative drugs confirm that geriatric patients achieve a given drug effect at plasma concentrations that are significantly lower than those required for young adults. In addition, the minimum alveolar concentration (MAC) of volatile anesthetic agents is less in the aged patient than in young adults. The decreased anesthetic and analgesic requirements in the aged patient are correlated with the reduction in brain mass, the decrease in cerebral blood flow, and the decrease in the number and density of neurons and axons in both the central and peripheral nervous systems. These decreases and reductions occur in geriatric patients even in the absence of disease.

Other factors may play a significant role in reducing anesthetic requirements in the geriatric patient. It may be that this decreased anesthetic requirement is a result of decreased functional reserve of the nervous system rather than decreased nervous system function. Regardless of the reasons for the pharmacokinetic and pharmacodynamic alterations of anesthetic agents observed in the geriatric patient, each patient must be examined on an individual basis and anesthetic doses titrated to best achieve goal-directed therapeutic or anesthetic effects. Some of the clinical consequences of these alterations are predictable but they do not apply consistently to all patients, or to all the preanesthetic and anesthetic agents used.

Preanesthetic Drugs

The preanesthetic medications used in a particular geriatric patient will depend on that individual patient’s physical condition, the amount of sedation or analgesia required, and the experience and preference of the veterinarian. Commonly used preanesthetic medications include anticholinergic agents, tranquilizer/ sedatives and opioid analgesics (Table 1). Individual drugs, as well as drug classes, are described in detail elsewhere.

Selecting medications that tend to create a smooth transition from awake to asleep and asleep to awake is an important goal.

In general for any higher-risk patient, this may include an opioid and a multimodal approach to anesthesia and analgesia that will tend to maintain good tissue perfusion.

• Anticholinergic Agents. Anticholinergics have been used

to counteract vagal bradycardia and to decrease respiratory secretions. The two drugs most commonly used have been atropine and glycopyrrolate. Currently, the anticholinergics are used less often as the favorable aspects of lower heart rates

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Table 1: SUGGESTED DOSAGES FOR PREANESTHETIC MEDICATIONS IN THE GERIATRIC DOG AND CAT for geriatric patients. The mild tranquilizing action is DOG CAT reinforced in combinations with ANTICHOLINERGICS opioids. The relatively minimal Atropine sulfate 0.22 mg/kg IM Same 1-1½ hours cardiopulmonary depression produced by the benzodiazepines Glycopyrrolate (Robinul V) 0.01 mg/kg IM, slowly IV Same 2-3 hours and the lack of severe sedative TRANQUILIZERS/SEDATIVES effects makes this drug class mg/kg IM, IV Acetylpromazine (Acepromazine) 0.01 3-6 hours appropriate for many geriatric maximum total dose of 1 mg Same patients. Prolonged mild CNS 0.1-0.4 mg/kg slowly IV Diazepam (Valium) ½-3 hours depression and disorientation maximum total dose of 10 mg Same can occur infrequently with Midazolam (Versed) 0.1-0.4 mg/kg IM, IV Same < 2 hours the benzodiazepines. This is OPIOID ANALGESICS more likely in aged animals, 1hour, dog including those with decreased Butorphanol (Torbugesic) 0.1-0.4 mg/kg IM, IV Same 2-4 hours, cat liver function. The specific Buprenorphine (Buprenex) 0.01-0.03 mg/kg IM, SC, IV Same 6-8 hours benzodiazepine antagonist, Fentanyl or Remifentanil 0.001-0.01 mg/kg Same 15-30 minutes flumazenil, may be useful in counteracting residual CNS mg/kg IM, IV, Hydromorphone or Oxymorphone 0.05-0.2 2-4 hours maximum total dose of 4 mg Same effects when they occur, Morphine 0.05-1 mg/kg IM, slowly IV Same 3-6 hours or to differentiate between residual benzodiazepine effect Meperidine 0.5-3 mg/kg IM, IV Same 1-2 hours and other CNS deficits. The Methadone 0.1-0.5 mg/kg IM, IV Same 1-3 hours benzodiazepines are also useful for select geriatric patients have been increasingly appreciated. The indiscriminant use in combination with the dissociative anesthetic ketamine. of anticholinergics should be avoided in the geriatric patient to prevent and avoid unwanted, and potentially dangerous, For the healthy geriatric patient, low-dose acetylpromazine sinus tachycardia from occurring. The heart of the geriatric (acepromazine) is a reasonable, although most often patient may not be able to tolerate the increased oxygen unnecessary, choice for a preanesthetic. The circulatory actions demand and consumption needed to support a dramatically of acetylpromazine are significant and could be potentially increased heart rate. Tachycardia in the geriatric patient deleterious to the compromised geriatric patient. At low doses may thus precipitate acute myocardial hypoxia and failure. and with appropriate physiologic support, this tranquilizer If problematic sinus bradycardia occurs, an anticholinergic can be useful in some aged animals. Remarkably low doses may be administered to effect, with careful titration to of acetylpromazine can be effective and adequate in the avoid tachycardia. If potent vagotonic drugs are to be given geriatric patient, particularly if the tranquilizer is combined such as some of the opioids like fentanyl, methadone or with an opioid analgesic. Volume expansion, through IV fluid morphine, an anticholinergic occasionally may be warranted. support, partially compensates for the hypotensive action of Half of the normal dose of anticholinergic may be given acetylpromazine and helps promote metabolic elimination. by intramuscular (IM) injection as a preanesthetic with Maintenance of acceptable blood pressure is verified by additional anticholinergic given IV to effect, if needed. monitoring during anesthesia. The use of acepromazine can contribute to undesirably prolonged recovery from anesthesia, • Tranquilizers/Sedatives. There is often very little need particularly in patients with limited hepatic function. for substantial preanesthetic sedation or tranquilization in older patients. The excitement of the youngster and the The alpha-2 agonist sedatives xylazine (Rompun, Anased) vigilance of the young adult gives way to the calmer and and dexmedetomidine (Dexdomitor) should be used with more often tractable demeanor of the aged patient. Reduction caution in geriatric patients. As useful as this group of of the stresses associated with hospitalization, procedures, drugs can be in healthy younger patients, the substantial and anesthesia and surgery may, however, be desirable. circulatory effects of standard doses of the alpha-2 agonists The judicious application of tranquilizers or sedatives is precludes their use at standard doses, or relatively high doses, often appropriate in geriatric patients, but careful selection, in most geriatric animals. When these drugs are chosen, the conservative dosing and close attention to detail is mandatory. availability of specific antagonists to reverse the circulatory, Pharmacodynamic changes associated with aging suggest respiratory and CNS effects can add considerably to the safety a general reduction in the dose for CNS depressing agents. of the technique if reversal is carefully administered. Very low doses of dexmedetomidine (0.5-1.0 micrograms/kg, IV) The benzodiazepine “minor tranquilizers” diazepam Continued on Page 21 (Valium) and midazolam (Versed) are often recommended DRUG

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• Combinations. Combinations of an opioid with a tranquilizer or sedative (Table 2), can be very effective in geriatric patients.

The pharmacologic effects of a combination will depend on the tranquilizer/sedative and opioid used. Combinations used with local anesthetics, along with appropriate monitoring and support, may be very appropriate for minor diagnostic or surgical procedures in the geriatric patient. As with any patient, cardiopulmonary function should be closely monitored as these combinations of CNS depressant drugs may produce increased respiratory or hemodynamic depression ranging from slight to significant.

can be beneficial in preventing or reducing the deleterious and maladaptive effects of perioperative and critical care stress.

Reversal should not be necessary, nor would it be desirable, in this context.

• Opioid analgesics. Opioids are often used alone or in

combination with tranquilizers in the geriatric patient as preanesthetic medications. Various opioid agonists have great utility, including morphine, oxymorphone, hydromorphone, meperidine, fentanyl and remifentanil. The opioid agonist/ antagonists and partial agonists (e.g., butorphanol and buprenorphine) also have great value in geriatric patients The advantages of the opioids for many other patients can be particularly valuable in the geriatric animals. As a group, the opioids produce effective analgesia and sedation with minimal or no direct cardiac depression. Bradycardia can be induced by some opioids, notably morphine, methadone and fentanyl, but this is a vagal reflex that can be prevented with use of an anticholinergic if deemed necessary. A reduction in heart rate may be desirable for many aged patients to reduce myocardial oxygen demand and consumption.

Injectable General Anesthetic Agents

Injectable general anesthetic agents are used with added care in geriatric patients because of the typically altered hemodynamics, pharmacokinetics and pharmacodynamics; decreased plasma protein binding; and the decreased ability for hepatic metabolism and renal excretion in aged animals.

• Alfaxalone (Alfaxan). Alfaxalone is a steroidal anesthetic

The respiratory depressant actions of opioid analgesics are rarely of clinical significance in healthy young patients.

The geriatric patients, however, may be at an increased risk of any respiratory depression. Additional attention to ventilatory function, the potential for depression and to the potential need for support of ventilation is required for geriatric patients. The risk of respiratory effects does not minimize the value of this group of drugs for older animals.

The “ceiling effect” on respiratory depression produced by the agonist/antagonist opioid butorphanol and the partial agonist buprenorphine has increased the usefulness and popularity of these opioids for geriatrics. The limited analgesic efficacy of butorphanol is importantly managed by the additional use of complementary analgesic strategies. For example, butorphanol may be used to provide a portion of the desired sedative action along with the concomitant use of synergistically contributing classes of analgesics, such as a local anesthetic or regional analgesic, as a part of a “balanced analgesic” approach.

Alternatively, a subsequent dose of a more effective opioid may be given later as a component of the anesthetic for better analgesic contribution after achieving the sedative benefits of butorphanol during preanesthetic care. A relatively low dose (to reduce dose-dependent ventilatory depression and perhaps sedation) of a pure agonist opioid analgesic — such as morphine, methadone, hydromorphone, oxymorphone or fentanyl — may be used when analgesic efficacy is required.

Buprenorphine provides useful opioid efficacy as a component of multimodal or balanced approach to pain management.

Emphasis on local anesthetics has greatly relieved our earlier reliance on the pure-agonist opioids which have been limited by issues of availability.

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with a short duration of action and generally smooth characteristics of induction and recovery, similar in use to propofol in many regards. Occasionally, hypertonus or agitation may occur at low doses and during recovery. These are more prominent in the absence of sedatives or tranquilizers and respond well to corrective small doses of sedatives. Alfaxalone is free of the histamine-releasing tendencies that were seen with the previous generation of related steroidal anesthetics and may be seen with propofol. Alfaxalone is typically used as an IV anesthetic but also is used (extra-label in the U.S.)

by IM injection. IV administration, titrated to achieve the desired anesthetic effect, may follow IM administration. In this application technique, it can be used for both a preanesthetic sedative combination and then as top-up doses, or a controlled rate infusion, to achieve and maintain anesthesia. The clearance and fast recovery are fairly similar to propofol. Hemodynamics are reported to be considerably more stable than with similar uses of propofol. (2, 4)

Table 2: OPIOID + TRANQUILIZER OR SEDATIVE COMBINATIONS FOR THE GERIATRIC DOG AND CAT SEDATIVE OR TRANQUILIZER:

OPIOID

Acetylpromazine 0.01 mg/kg IM, SC, or IV not to exceed a maximum total dose of 0.5 mg

Hydromorphone or Oxymorphone 0.1-0.2 mg/kg IM, SC, or IV

Diazepam or Midazolam 0.1 to 0.4 mg/kg slowly IV to a maximum total dose of 10 mg

Hydromorphone or Oxymorphone same as above

Acetylpromazine--same as above

Meperidine 0.5-3 mg/kg IM or slowly IV

Acetylpromazine--same as above

Butorphanol 0.1 to 0.4 mg/kg IM, IV

Diazepam or Midazolam--same as above

Butorphanol--same as above

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• Dissociative Anesthetic Agents.

Ketamine and the dissociate/tranquilizer combination Telazol should be used with caution in geriatric dogs and cats with preexisting cardiovascular or pulmonary dysfunction. As with the anticholinergic preanesthetic medications, the sinus tachycardia produced by the dissociative anesthetics may be disadvantageous in the geriatric patient because of the marked increase in oxygen demand and consumption. The geriatric patient may not have the cardiac reserve to withstand this increased heart rate. The dissociative agents may also exacerbate any pre-existing pulmonary dysfunction and further compromise the patient. Patients with renal or hepatic dysfunction may be expected to have prolonged recovery times.

Elimination and recovery from the dissociatives requires hepatic metabolism, more so in dogs than in cats. In geriatric patients with impaired liver function, conservative administration of the dissociatives, perhaps supplemented with the use of opioids or other CNS depressants, is recommended. Recovery from dissociative anesthetics can be accompanied by delirium.

Administration of a low dose of midazolam (0.1 mg/kg, IV) or a very low dose of dexmedetomidine (0.5 to 1.0 micrograms/ kg, IV) is usually quite effective in smoothing an otherwise rough recovery, preventing disadvantageous stress, delirium and increased oxygen demand. Continued and extended dedication to attentive patient monitoring and physiologic support increases patient safety and, ultimately, clinical success whenever additional CNS depressant medications are needed.

• Propofol (PropoFlo, PropoFlo-28, Diprivan, Rapinovet).

Propofol is well-suited for induction of anesthesia in many geriatric patients since recoveries are consistently rapid and complete. Because its cardiopulmonary depressant effects are dose-dependent and substantial, propofol should be used with caution in any geriatric patient with pre-existing cardiopulmonary disease or dysfunction. Recovery is very rapid following even repeated doses of propofol. It is rapidly redistributed and metabolized in both dogs and cats. Residual drug effects are minimal with propofol. There does not appear to be the problem of drug buildup with propofol when compared to the dissociative agents when multiple doses or infusions are given. Propofol (as a phenol compound) and the benzyl alcohol preservative that is present in the extended shelf-life version (PropoFlo-28) have the potential to increase deleterious oxidative stress effects to red blood cells. With doses typically used for induction of anesthesia, cats tolerate both propofol and PropoFlo-28.5 As described elsewhere, multiple doses or infusions of propofol in cats should be reasonably limited in geriatric cats since phenols are poorly conjugated and toxicities could develop.

• Etomidate (Amidate).

Etomidate has been a valuable injectable anesthetic for geriatric patients with clinically significant cardiovascular compromise, most notably unstable heart failure. The agent produces a rapid induction of anesthesia, and a rapid and usually smooth recovery.

Occasionally, there are problems with excitement during induction or recovery from etomidate, but this seems less common in geriatric patients and is largely avoided by use

22 | FVMA ADVOCATE

of mild preanesthetic sedation. Administration of an opioid, plus a small dose of diazepam or midazolam (0.1 mg/kg, IV), is effective in controlling this side effect. The rapid hepatic hydrolysis of etomidate allows for very rapid recovery even when multiple doses or infusions of etomidate are used.

At doses used to produce general anesthesia in geriatric dogs and cats (typically 1-3 mg/kg, IV), etomidate produces no change in heart rate, cardiac output or mean arterial blood pressure.

Cardiovascular stability is remarkable with etomidate, in part because it better maintains baroreceptor-mediated responses.

Etomidate has been demonstrated to temporarily inhibit adrenal steroidogenesis in humans and dogs. Whether or not this inhibition is significant, and if so whether it is detrimental or beneficial to the veterinary patient, is controversial. An increase in overall fatalities in the weeks following etomidate anesthesia in humans has been noted. Etomidate does produce a mild to moderate dose dependent respiratory depression.

Inhalant General Anesthetic Agents

Inhalant general anesthetics are the anesthetics of choice in the many small animal patients, especially for procedures lasting longer than 10 to 15 minutes. The newer inhalants sevoflurane (SevoFlo, Ultane) and desflurane (Suprane) offer the considerable advantage for geriatric patients of rapid to very rapid adjustment of inhaled and alveolar anesthetic dose and effect. Isoflurane and sevoflurane have become well-established in veterinary anesthesia for use at appropriate doses in most patients, including many relatively compromised geriatric patients.

Dose-dependent vasodilatation and hypotension preclude the use of higher doses of inhalant anesthetics in geriatrics and many higher-risk patients. Dose sparing contributions achieved through the contributory use of lower doses of synergistically acting injectable agents allow for the maintenance of partial intravenous anesthesia (PIVA) with comparatively low doses of inhalants. As the saying goes, “less is more.” In more extreme cases, injectable agents are best used without inhalants (total intravenous anesthesia, or TIVA) and often can support markedly improved hemodynamics. Inhalational induction of anesthesia — either by mask or chamber — is relatively contraindicated in almost all clinical situations, especially for geriatrics and other higher-risk patients.1

• Isoflurane. Heart rhythm is extremely stable with isoflurane.

Isoflurane depresses respiration in a dose-related fashion.

Isoflurane, like the other inhalant anesthetics, will produce a transitory decrease in renal blood flow, glomerular filtration rate and urine flow, yet no direct renal toxicity has been reported.

There are no major precautions or specific contraindications to the use of low doses of isoflurane in geriatric patients.

• Sevoflurane and desflurane. These two newer volatile

anesthetics provide for a more rapid adjustment of anesthesia.

The more rapid and smooth transition can minimize the delay in return of normal control of the patient’s airway.

Recovery from these two inhalants is rapid. In order to provide for a smooth and comfortable recovery in geriatric patients, it is necessary to use appropriate clinical finesse as

well as to always use appropriate analgesics, along with the judicious use of tranquilizers and sedatives as noted above.

The second part of this series covered the pharmacology associated with anesthesia use with senior pets, and the next article in the series will wrap-up our three-part series with reviewing other considerations when it comes to using anesthesia in the geriatric patient.

References

1. Bednarski R, Grimm K, Harvey R, Lukasik VM, Penn WS, Sargent B, and Spelts K. AAHA anesthesia guidelines for dogs and cats. Journal of the American Animal Hospital Association 2011; 47(6): 377-385.

2. Chiu KW, Robson S, Devi JL, Woodward A, Whittem T. The cardiopulmonary effects and quality of anesthesia after induction with alfaxalone in 2-hydroxypropyl-βcyclodextrin in dogs and cats: a systematic review. J Vet Pharmacol Ther 2016 May 18. doi: 10.1111/jvp.12312.

[Epub ahead of print].

3. McMichaels M. Critically ill geriatric patients. In: Silverstein D, Hopper K (eds): Small Animal Critical Care Medicine, 2nd ed. St. Louis: Elsevier, 2015, pp 825828.

4. Maney JK, Shepard MK, Braun C, Cremer J, Hofmeister EH. A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs. Vet Anaesth Analg 2013;40(3):237-244.

5. Taylor PM, Chengelis CP, Miller WR, Parker GA, Gleason TR, Cozzi E. Evaluation of propofol containing 2% benzyl alcohol preservative in cats. J Feline Med Surg.

2012;14(8):516-526.

Ralph Harvey, DVM, MS, DACVAA

Dr. Ralph Harvey teaches anesthesia and pain management in the Department of Small Animal Clinical Sciences at the University of Tennessee College of Veterinary Medicine (UTCVM) in Knoxville, Tennessee. He previously served as the section head for the Small Animal Surgical Services and is a member of the University Faculty Senate. His veterinary degree is from the UTCVM and his post-graduate training includes an internship, residency and fellowship at Cornell's Veterinary and Medical Colleges.

Dr. Harvey has worked in private small animal practice. He is certified as a specialist by the American College of Veterinary Anesthesia and Analgesia, and he has served as their executive secretary and as a member of the ACVAA Board of Directors.

He is currently a member of the Fear-Free Advisory Panel and Executive Council.

PRACTICE GOT A QUESTION? THE FVMA CAN HELP. One of the benefits of membership in the FVMA is our Helpline, 800.992.3862, available to members daily, Monday to Friday, 8:00 a.m. to 6:00 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, in an effort to keep our members up-to-date on current concerns as well as regulatory and legislative changes.

QUESTION:

I currently work at two veterinary clinics (clinic A and clinic B) which are about 10 minutes from each other. These two clinics used to be owned by the same owner; however, one of the clinics was recently sold to another associate so the two clinics are no longer under the same ownership. On occasion, one clinic may run out of stock of a medication and when the clinics were under the same ownership we would send a client from one clinic to another to pick up a prescription if needed. We are still planning to operate the two clinics as sister clinics even after the change in ownership. Would I still be able to send a client to the other clinic to pick up a medication if needed?

In this case, the veterinary-client-patient relationship exists between myself and the client and patient at clinic A, but clinic B does not have any records or a current examination for this patient.

However, I work at and prescribe medications at both clinics and I have examined the patient within the last year and have a current veterinary-client-patient relationship with this client and patient.

Would I legally be able to prescribe a medication to this patient from clinic B if needed?

A: Once the two clinics are no longer under common ownership this practice is no longer acceptable. A veterinary practice may operate out of several different locations, and a patient of “the practice” remains a patient regardless of the specific clinic the patient was treated. Once “the practice” is split up into two separately owned practices, then the patient is the patient of the particular clinic the patient was treated at a veterinary practice cannot act as a pharmacy to fill the prescription of another veterinarian. Although you may work at both clinics, if you never examined/treated the animal or has records at clinic B, then the patient is not a patient of clinic B.

QUESTION:

I want to have the local animal control do a wellness check on a residence because we suspect the owner is collecting cats and neglecting them. How much information can I give the staff at animal control about the client and pets? Additionally, our local animal control told my staff that local ordinances dictate that veterinarians

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cannot request wellness checks or report clients for possible animal abuse and neglect. This appears counter to my moral obligation as a veterinarian. Is there a state law or part of the practice act that would override a county ordinance? I cannot find said ordinance in the animal services ordinances for Clay County.

A: Advice from our legal counsel is that you cannot report on your client, a position governed by Chapter 61G18-18.002 Maintenance of Medical Records. (5) reads: (5) A veterinarian shall maintain confidentiality of all patient records in his/her possession or under his/her control. All patient records shall not be disclosed without the consent of the client. Appropriate disclosure may be made without such consent: (a) in any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice by the party seeking such records to the client or his/her legal representative; (b) when required by the Board’s rules.

QUESTION:

I have received a subpoena to provide medical and financial records of a deceased patient whose owner is being sued. Can I comply with this subpoena without consent of the owner?

A: Yes, you may comply with this subpoena without consent of the owner. The regulation is below: 61G18-18.002 Maintenance of Medical Records.

(5) A veterinarian shall maintain confidentiality of all patient records in his/her possession or under his/her control. All patient records shall not be disclosed without the consent of the client. Appropriate disclosure may be made without such consent: (a) in any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice by the party seeking such records to the client or his/her legal representative;

QUESTION:

Do I need to collect driver’s license numbers (or check IDs) for clients in order to dispense a controlled substance? I currently do not collect driver’s license numbers or social security numbers for clients, but I found FSA 893.055 which states to dispense a controlled drug to someone "not known to such dispenser", we need a valid photo ID. Does this apply to clients of a veterinary practice?

A: 893.055 does not apply to veterinarians. (1) (f) says: “Health care practitioner” or “practitioner” means any practitioner licensed under chapter 458, chapter 459, chapter 461, chapter 463, chapter 464, chapter 465, or chapter 466. Veterinarians are licensed under chapter 474.

QUESTION:

We are wondering what the current rules are concerning dispensing/ prescribing compounded medications. Do we send a prescription to a compounding pharmacy and they will make up medication for a specific patient, or can we have compounded meds on the shelf and dispense to our patients in-house?

Our understanding is that we cannot have a bottle of compounded medication on the shelf and dispense from it to multiple patients.

Just checking if things have changed.

A. Through the efforts of the FVMA, the pharmacy statute on “Dispensing Practitioners” was amended a few years ago to add a paragraph 5, which states: 465.0276 Dispensing practitioner.— (5) This chapter and the rules adopted thereunder do not prohibit a veterinarian licensed under chapter 474 from administering a compounded drug to a patient, as defined in s. 474.202, or dispensing a compounded drug to the patient’s owner or caretaker. This subsection does not affect the regulation of the practice of pharmacy as set forth in this chapter.

The Florida Board of Pharmacy has a rule on compounding, and the rule does not allow the re-sale of compounded drugs by physicians for human patients, but does allow resale by veterinarians. If you look at the requirements of the rule, the label of a compounded drug must provide the statement “For Institutional or Office Use only-Not for Resale,” or if the drug is provided to a veterinarian, the statement “Compounded Drug.”

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QUESTION:

A local veterinarian spoke to the owner and full-time veterinarian at our hospital. This local veterinarian asked if we were still seeing a certain client and her dogs. This client has a senior dog on a few medications, but most importantly Tramadol, Diazepam and Gabapentin. The other doctor said this client told her in February 2017, that she was switching to her practice from our practice. This is the first we have heard of this, because we have no records of any transfer, faxed/emailed records, permission to send records or any of the usual information about a transfer. We do have several records for this particular pet being sent to specialists and kennels over the last couple of years. The other veterinarian believed, as was reported to her by the owner, that she was now going to her instead of us, so she believed it was authorized to speak with our veterinarian about her pet.

We have also been seeing the pets of this client consistently, and filling medications (not written Rx but actual dispensing the medications).

Last March, this client told one of our relief vets that she was seeing the other veterinarian and the relief doctor said that we could not dispense any seizure related meds until we had complete medical records from all veterinarians. The client then began to complain that her pet was having anxiety, so she needed medications for that.

(We never received any records from any other veterinarians). She has been calling to get a refill of Tramadol. I do not know how this should be handled.

A: All professionals that are authorized to prescribe or dispense controlled substances have a duty to prevent the diversion of controlled substances. In pharmacy, there is a term “red flags” to describe suspicious circumstances that may cause a pharmacist to question the legitimacy of a prescription.

This term is also applicable here. This client has exhibited “doctor-shopping” behavior and appears to be getting meds from more than one veterinarian. That is a huge red flag. Our suggestion is for the doctor to tell the client that she can no longer treat her pets and that all records for all her pets are ready to be transferred to the other local vet (or any other vet of her choosing) and that only that other vet will be prescribing/ dispensing.

END NOTE: The ultimate responsibility in the practice of veterinary medicine lies with the licensed veterinarian. Professional discretion must always be exercised.

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CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED

VETERINARIAN WANTED – DELAND, FL: We are looking for a motivated and energetic veterinarian to join our ever-growing, always open and fully staffed 24-hour practice. We are a full-service small animal veterinary hospital providing quality medicine in a friendly, compassionate environment. Our hospital currently staffs over 30 full time employees including 10 doctors, one which is board certified (DACVT). We strongly encourage client education and preventive medicine as well as dealing with a wide range of illnesses, injuries, and emergency care. In addition to general and emergency medicine we also offer orthopedics (bone plates, lateral sutures, TTA) oncology, behavior, reproduction (freezing semen, surgical AI) and exotic medicine (avian, pocket pets, reptiles, venomous snakes, sea turtles). Some of our equipment includes a CT scanner, digital x-ray, ultrasound, therapy laser, surgical laser, endoscopy, platelet rich plasma transfusions and stem cell therapy. We supplement our packages with health insurance, compensated CE, vacation, professional dues. Salary varies and is dependent upon experience and shifts worked. Exotic and surgical experience is a plus. We look forward to hearing from any and all applicants who find the above interesting. We do have the ability to be flexible with hours and shifts for the right applicant Our daytime veterinarians have a flexible schedule. A few doctors prefer 5 shorter shifts followed by 2 days off.

Most prefer the 4 longer days and 3 days off. Our emergency veterinarian will work an average of 10 to 12 shifts a month with a flexible schedule. We have 3 emergency veterinarians that can plan a rotating schedule that will fair and at the same time balance work and personal time. We help pay student loans we have excellent health insurance. Please contact via email at tomdvm@hotmail.com. (5/18; ID#664) PART-TIME VETERINARIAN WANTED – SOUTH TAMPA, FL: South Tampa Veterinary Care is looking for part-time associate veterinarian. STVC is a steadily expanding, privately-owned single doctor practice. Candidates should be interested primarily in basic soft tissue surgery and dentistry with extractions. We have Vetter EMR, Konica digital whole body and Progeny dental X-ray, BioNet and Scil multi-parameter monitors, Abaxis in-house lab, Antech outside lab, Sound portable ultrasound and Respond cold laser. We offer on-site board certified IM consults and SX procedures.

No emergencies or on call. Looking for a friendly, practical, client informing and client responsive DVM to join our clinic. We offer CE, dues, licensure fees, liability insurance. Contact stvcbiz@yahoo.com. (5/18; ID#11602) VETERINARIAN WANTED – LONGWOOD, FL: 434 Animal Hospital in Longwood, FL (a suburb of Orlando) is seeking to hire a full or part time Associate Veterinarian to join our two doctor small animal exclusive practice.

See https://www.434animalhospital.com/employment (5/18; ID#16675) VETERINARIAN WANTED – BROWARD COUNTY, FL: Vetfield Animal Hospital is seeking a part-time/full-time veterinarian to join our team in Broward County, FL. Our hospital is well-equipped with stateof-the-art diagnostic laboratory including digital radiology, new in-house blood machines and laser therapy. Compensation is based on schedule worked and experience (profit sharing is available as well). We welcome new graduates as well as experienced veterinarians. Bi-lingual ability is a plus, and we are centrally located 15-20 minutes next to major highways, shopping, the airports and the beach! Contact rahman@vetfield.com.

(5/18; ID#17406) VETERINARIAN WANTED – THE VILLAGES, FL: Veterinarian for well established non-profit small animal wellness and vaccination clinic that has served the community for 17 years. Includes check-ups on the general welfare of dogs and cats. Proficient in diagnosis and treatment for variety of complaints such as allergies, skin conditions, dentals, etc., as well as minor surgeries, i.e., small tumor removals, cat declaws, and spay/neuter. Services needed 5 hours daily, 1 or 2 days weekly. Salary range up to $57k. Excellent growth potential. Contact Joy Creech, president and director of the CARES Center, 735 E. C. 470, Lake Panasoffkee, FL 33538. Tel: 352-568-9994.

Located near The Villages. (5/18; ID#18706) VETERINARIAN WANTED – TAMPA BAY, FL: Trinity Pet Hospital, Inc., seeks to add a third full time veterinarian. We are a dog and cat hospital giving our clients the latest in diagnostic and therapeuticregimens. Your

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skills will be well utilized in this busy, growing clinic. We have four graduate certified technicians whose skills are also well utilized. We are outpatient only - no kennel, no grooming. If overnight care is needed, we refer to nearby emergency clinics. We are open Monday through Friday, with a half day Saturday. Closed Sunday and major holidays with after hours calls referred to nearby emergency clinics. Trinity Pet Hospital is located in the Greater Tampa Bay area in Florida, home to Florida's best beaches and great outdoor activities. Please send resume with contact information to Dr. Scott Lamb via E-mail to scottlamb1948@gmail.com. (5/18; ID#293) VETERINARIAN WANTED – PARRISH, FL: Well-established small animal practice located on the west coast, looking for a full-time veterinarian.

We provide full-service medical, dental, and soft tissue surgical procedures.

We have in-house IDEXX vet lab stations, digital radiography, ultrasonic dental equipment. NO after-hour/emergency shifts. Great supportive staff, competitive salary. Benefits include: Insurance, 401-K, 2 weeks PTO, and CE. For contact Kelly Stoddard at eah34219@aol.com (5/18; ID#28303) VETERINARIAN WANTED – MARGATE, FL: Associate position small animal practice Margate, Broward County, established 1974; Charles Byron DVM, 2531 N St Rd 7, Margate, Fl 33063. Phone 954-974-1136, Fax 954984-0214, and Email: cbyron@bellsouth.net. (5/18; ID#5910) VETERINARIAN WANTED – PORT CHARLOTTE, FL: The Animal Clinic, Port Charlotte, FL.The Animal Clinic is a small animal, AAHA accredited facility located in sunny Port Charlotte, Florida looking for a third doctor to join our practice. We are a full-service veterinary practice who care for a variety of patients including dogs, cats, birds, reptiles, amphibians, rabbits, guinea pigs, ferrets, chinchillas, hamsters, gerbils, mice, sugar gliders, and rats. Our team is seasoned and highly trained focused on providing the best quality medicine and are well-equipped with ultrasound, digital x-rays, separate dental suite and more! At our hospital we offer a flexible schedule and great work/life balance in addition to a competitive salary and benefits (health, 401k, CE, etc.). If you are interested please email Meagan Underwood, munderwood@svp.vet to set up some time to discuss further! (5/18; ID#42504) VETERINARIAN WANTED – PARRISH-BRADENTON, FL: Dr. Nina’s Animal Hospital, Parrish-Bradenton, FL. At Dr. Nina's Animal Hospital, we are proud to provide skilled, quality veterinary care to the pets of Sarasota and Parrish. Dr. Janina Krajewski, our clinic's veterinarian, has been working with pets at Dr. Nina's Animal Hospital since the clinic opened its doors in 2007 and is well-known in the community and great presence on social media. Dr. Nina's Animal Hospital provides preventative care, urgent care, emergency services and standard medical procedures. We believe that preventative care and pet owner education can help save pets in the Sarasota and Parrish areas. We have a team of amazing doctors, Dr. Lyda Torres and Dr. Amber Sherry in the Parrish location and Dr. Nina, Dr. Ashley McNamee and Dr. Del Anderson in Sarasota. We are looking for an Associate Veterinarian who enjoys working as team and an individual with positive energy, enthusiasm, and willingness to bond with staff, clients and patients.

At our hospital we offer a flexible schedule and great work/life balance in addition to a competitive salary and benefits (health, 401k, CE, etc.). If you are interested please email Meagan Underwood, munderwood@svp.vet to set up some time to discuss further! (5/18; ID#42504) VETERINARIAN WANTED – PENSACOLA, FL: Safe Harbor Animal Hospital, Pensacola, FL. Safe Harbor Animal Hospital provides quality veterinary care to dogs, cats, pocket pets, and exotics in Pensacola, Florida.

We have a team of 25 plus caring individuals including 5 full time and 2 part time veterinarians. Equipment includes Avimark practice management software, CR digital x-ray, ultrasound, Companion therapy laser, and in-house chemistry and CBC machines. We are currently seeking a family/ client-oriented Associate Veterinarian who enjoys working as team and an individual with positive energy, enthusiasm, and willingness to bond with staff, clients and patients. Interest in exotics/acupuncture/alternative medicine a plus. In addition to a flexible schedule, great work/life balance, competitive salary and benefits (health, 401k, CE, etc.), we are also offering a relocation and sign-on bonus for this position. If you are interested please email Christine Fernandez, cfernandez@svp.vet to set up some time to discuss further! (5/18; ID#42504)

VETERINARIAN WANTED – JUNO BEACH, FL: Juno Beach Animal Hospital, Juno Beach, FL. Juno Beach Animal Hospital is a full-service, small animal veterinary hospital providing comprehensive medical, surgical and dental care. We currently have two experienced doctors and are looking for a third doctor to join our team! Open since 1979, we are well-established with our community and have an excellent reputation. We practice high quality medicine and our beautiful facility includes a pharmacy, surgery suite, separate dental area and is well-equipped with everything you may need! At our hospital we offer a flexible schedule and great work/life balance in addition to a competitive salary and benefits (health, 401k, CE, etc.). If you are interested please email Christine Fernandez, cfernandez@svp.vet to set up some time to discuss further! (5/18; ID#42504) VETERINARIAN WANTED – JACKSONVILLE, FL: Herschel Animal Clinic, Jacksonville, FL. Herschel Animal Clinic is a small animal, fast paced, 4 doctor practice in the historic Avondale area in Jacksonville, FL looking for an additional Associate Veterinarian to join our team! Open since 1960, we are a long-standing clinic that focuses on providing the best care possible for clients pets. We are looking for an Associate Veterinarian who has a strong interest in surgery and driving the hospital to its fullest potential.

In addition to a competitive salary and benefits (health, 401k, CE, etc.), we are also offering a relocation and sign-on bonus for this position. If you are interested please email Christine Fernandez, cfernandez@svp.vet to set up some time to discuss further! (5/18; ID#42504) VETERINARIAN WANTED – TAVERES, FLORIDA: Veterinarian-Spay/ Neuter surgical veterinarian full time needed for non-profit high-quality clinic. Open 4 days a week, 20 to 25 surgeries a day. Good starting pay, willing to negotiate and have well trained, motivated staff. Our clinic has a very fun, family atmosphere that is always looking new perspectives. Please contact: Kent Weber kent@misfitclinic.org or 407-595-0738. (5/18; ID#9688) VETERINARIAN WANTED – TAMPA, FL: Westchase Veterinary Center, located in sunny Tampa, FL, is looking for an Associate Veterinarian to join our growing practice! Our hospital will be DOUBLING in size to 6,000 sq ft, and we need to ADD a 5th doctor. We are a well-established, full-service, small animal veterinary hospital and occasionally work with some exotics.

We have a friendly, knowledgeable staff focused on providing high quality medicine as a team. We are a progressive clinic with continual growth of the practice expected over the next few years! We are expanding to give our hospital more room for treatments, examinations, and surgeries. Our ideal candidate will either be a new graduate or have practice experience and will exhibit strong community leadership while providing a passionate and caring hand to our neighborhood friends. Interest in alternative medicine a plus! We're looking to expand our services to include acupuncture. Interest in exotics is a plus. For more information, please visit our website at www. westchasevet.com. Please submit resumes to smoss@nvanet.com (5/18; ID#42549) VETERINARIAN WANTED – SOUTH TAMPA, FLORIDA: Gandy Animal Hospital located in South Tampa, FL is looking for an Associate Veterinarian to join our practice! We are a three doctor AAHA-accredited veterinary hospital in the heart of beautiful South Tampa. We have an exceptional support staff that includes 11 veterinary technicians; a great client base; and pride ourselves on practicing exceptional evidence-based medicine with a strong focus on client education. We are a positive workplace and would like to complement our current staff with a friendly, full-time associate who has strong medical and surgical skills, as well as exceptional client and interpersonal communication skills. We are looking for someone who loves what they do and enjoys the client/patient/veterinary relationship. Internship trained or 2+ years of experience ideal. Outstanding work environment, supportive co-workers, and a rapidly growing hospital. We are a modern facility that has served the greater Tampa Bay area for over 30 years, with an excellent reputation in our local community. For more information, please visit: www.gandyanimalhospital.com. Please submit resumes to smoss@nvanet.com (5/18; ID#42549) VETERINARIAN WANTED – WESTON, FLORIDA: Hometown Animal Hospital and Dental Clinic desires to hire an Associate Veterinarian to join our practice. Hometown Animal Hospital and Dental Clinic is a wellestablished clinic founded in 1999 with a special love and compassion for animals. We are looking for an associate to join our 3 veterinarians and highly skilled team. The ideal candidate will have a passion for dentistry and surgery, and a strong desire to work in a hospital practicing text book medicine. Each day we strive to deliver outstanding patient care by providing

the highest standard of veterinary medicine, employing dedicated staff, and offering outstanding customer service (we have over 600 Google reviews with a 4.9 rating. This has helped the clinic grow to a full-service facility; working to offer the best care for animals in the South Florida area. We offer in-house lab, digital dental and whole body radiology, ECG, certified anesthesia monitoring, and surgical equipment, a diverse caseload, and Dr. Jan Bellows is board certified as a dental specialist and by the American Board of Veterinary Practitioners as a dog and cat specialist. Mentorship and residencies are available at our facility. Exotics interest a plus. More information at http://www.hometownanimalhospital.net and www.Allpetsdental.com. Please submit resumes to smoss@nvanet.com (5/18; ID#42549) VETERINARIAN WANTED – TALLAHASSEE, FLORIDA: North Florida Animal Hospital in Tallahassee, FL, is seeking an Associate Veterinarian to join our team! North Florida Animal Hospital is an ever growing, fast paced, full-service AAHA accredited general practice animal hospital that holds the title of “Best of Tallahassee” Veterinary Hospitals for the past 12 years due to our focus on clients and their pets. We pride ourselves on employee satisfaction and retention and are proud to have many of our staff members celebrating their 10th year anniversary with us!

Our original DVM owners are still working hard to maintain the level of service that we have provided to the Tallahassee community for 30 years.

The owners are always looking for DVM staff interested in developing their own individual areas of expertise while working together as a team every day through rounds, discussion, and monthly meetings. For more information: https://nflah.com/. Please submit resumes to smoss@nvanet.com.

(5/18; ID#42549) VETERINARIAN WANTED – NICEVILLE, FLORIDA: Parkway Veterinary Hospital located in Niceville, FL on Florida's Panhandle, is looking for an Associate Veterinarian to join our team. Parkway Veterinary Hospital is an AAHA accredited, well-established small animal hospital that has been a part of the community since 1984. We are a busy and growing multidoctor practice with a focus on providing the highest quality of medicine and surgery to our patients. Our staff has excellent tenure, and create a welcoming and friendly environment for our clients. We also have excellent relationships with the nearby referral practices, and use them regularly for overnight emergency referrals. We are well equipped with: In-house IDEXX laboratory equipment, Full Digital radiographs including dental, ultrasound, and endoscopy. More information available at: http://www.mypvh.com/.

Our hospital is just 15 minutes from some of the “World’s Most Beautiful Beaches,” with white sandy beaches and emerald waters! With no weekend duty, spend your weekends relaxing on the beach with your toes in the sand!

Please submit resumes to smoss@nvanet.com (5/18; ID#42549) VETERINARIAN WANTED – ORLANDO, FLORIDA: Animal Hospital at Vista Lakes located in Orlando, FL is seeking an experienced Associate Veterinarian to join our team. We are a progressive and growing 3-doctor practice located in the heart of Orlando! Our Animal Hospital has been in operation since 2005 and we provide a variety of veterinary medical services for pets in Orlando to include dogs, cats, rabbits, and small pocket pets. Our hospital staff are like family, and we regularly do events for the staff such as pumpkin carving, stocking decorating, and small holiday parties. Our doctors also enjoy NO on-call or emergency as we are a member of the local emergency referral practice here in Orlando.

Our Certified technicians ensure continuation of care overnight for our hospitalized patients. We’re open 6 days a week, with Saturday hours of 8am – 12pm. We also offer a 4 day work week with rotating weekends. For more information: https://vistalakesah.com. Please submit resumes to smoss@nvanet.com . (5/18; ID#42549) VETERINARIAN WANTED – DEERFIELD BEACH, FLORIDA: Hillsboro Beach Animal Hospital located in Deerfield Beach, FL is looking for an Associate Veterinarian to join our practice. Hillsboro Beach Animal Hospital is a well-established, full-service, small animal veterinary hospital providing comprehensive medical, surgical and dental care. We provide a broad spectrum of diagnostic procedures through in-house testing and the use of external laboratories. We also work closely with local practices when special diagnostic procedures are required. At Hillsboro Beach Animal Hospital we strive to offer not only sound advice, but also optimal veterinary care to our patients and clients. Our job is not only to treat our client’s pets when he or she isn't feeling well, but also to help them learn how to keep their best friend happy and healthy. Quality and cost are two main aspects to

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consider when choosing treatment for any member of our client’s family, and we work hard to balance those needs while providing the best possible care for their pet. For more information: www.hillsborobeachanimal.com.

Please submit resumes to smoss@nvanet.com (5/18; ID#42549) VETERINARIAN WANTED – CORTEZ, FLORIDA: Beach Veterinary Clinic, located in Cortez, FL, is looking for an Associate Veterinarian to join our team! Established for over 30 years, Beach Veterinary Clinic is a modern and well-equipped veterinary hospital located between Bradenton and Sarasota, FL. We primarily see dogs and cats for various medical and surgical procedures. Our hospital consists of a full in-house IDEXX lab, ultrasound, full digital radiography, endoscopy, and tonopen. We have a very affluent clientele and have a very relaxed workplace environment.

Emergencies are referred to an emergency hospital close to our location after business hours. For more information, please visit Beach Veterinary Clinic on our website www.beachvetclinic.com. Please submit resumes to smoss@nvnaet.com (5/18; ID#42549) VETERINARIAN WANTED – NAPLES, FLORIDA: Animal Oasis Veterinary Hospital located in gorgeous Naples, Florida is looking for an Associate Veterinarian to join our growing team. Our modern facility boasts 5 exam rooms, a spacious treatment area, as well as separate surgery, dental, and radiology suites. Our elite team is comprised of three associates and is anchored by our managing veterinarian. We are needing someone with experience, that can multi-task and handle stress well. Our practice is very busy both in volume and the variety of cases that we see. We have highly trained and technically skilled support staff. We pride ourselves in practicing progressive medicine and excel in customer service. At Animal Oasis, we believe our clients and patients are the heart of our practice. We strive to ensure a happy experience through superior customer service, personalized care, and effective state of the art medicine. It is our mission to ensure our patients enjoy a lifetime of good health. Our clientele are very loyal and have awarded us Best Veterinary Practice in Collier County for the last two years.

Take a virtual tour at www.aovethospital.com! Please submit resumes to smoss@nvnaet.com (5/18; ID#42549) VETERINARIAN WANTED – PANAMA CITY BEACH, FLORIDA: Animal Care Center of Panama City Beach is looking for an Emergency Associate Veterinarian to join our practice! Excellent earning potential to make over $100k+ first year. Animal Care Center is located in the panhandle of Florida on the emerald waters and white sand of the Gulf of Mexico, known as “the World’s Most Beautiful Beaches.” We focus on providing the latest in small animal preventative and diagnostic medicine and general surgery.

ACC has a state-of-the-art facility with isolation ward, double surgery suite, ICU, in-house IDEXX lab, digital radiographs, Stem Cell Therapy, Tonopen, ultrasound, pharmacy, and more! We’re looking for a doctor with confidence in medical knowledge and skill, weekend and overnight availability, strong interest in emergency medicine, enjoys building relationships and educating clients. Please submit resumes to smoss@nvnaet.com (5/18; ID#42549) VETERINARIAN WANTED – WESLEY CHAPEL, FLORIDA: Quail Hollow Animal Hospital, an AAHA accredited facility, is hiring for a Managing Veterinarian to join our practice. We’re located in Wesley Chapel, about 30 minutes from downtown Tampa. Our facility is 13 years young but we have been providing excellent medicine for almost 25 years. Quail Hollow Animal Hospital provides primary care, laser surgery, pharmacy, in-house laboratory facilities, pet wellness plans, dental care, digital x-ray and digital dental x-ray, ultrasound imaging, anesthesiology and cold laser therapy. We treat dogs, cats, bunnies and a significant number of reptile and small mammals. We offer a competitive salary, full health benefits, 401K, CE allowance, paid time off, and licensing/professional dues. More information, visit www.quailhollowanimalhospital.com. Please submit resumes to smoss@nvnaet.com (5/18; ID#42549)

TECHNICIANS WANTED

VETERINARY TECHNICIAN WANTED – GULF GATE ANIMAL HOSPITAL -SARASOTA FLORIDA (2031 BISPHAM ROAD, 34231): .. a small animal practice where our patients and clients are valued and cared for like family. We are family owned and growing. We provide an environment where our staff is professional and caring and continually seeking to meet the needs of our clientele with patient care our priority.

We value education and aim to provide the most thorough and up to date medicine and surgery services for our patients. We value low stress, fear free approaches when handling our patients. Seeking an experienced technician to join our crew who has skills in venipuncture,

30 | FVMA ADVOCATE

catheter placement, +/-anesthesia monitoring and management, gentle handling, knowledge of basic preventative medicine including vaccines and parasite control and good communication skills.Please apply within, or download an application from www.sarasotavet.com and send. You may email us at sarasotavet@comcast.net or call 941-922-3917 and leave a message for Dr. Jeanette Cole (5/18: ID#25874)

RELIEF VETERINARIAN

RELIEF VETERINARIAN - FLORIDA: Need a relief veterinarian who will travel? Experienced over 30 years practice owner, 10 years relief work.

Small animal and Exotics. Travel throughout Florida State. Available Friday, Saturday, Sunday negotiable. Reliable, good clinical skills, excellent producer. Fluent in English and Spanish. References available.

Dr. Cesar Mena 786-258-2688 or docvetmena@gmail.com (5/18: ID#15333) RELIEF VETERINARIAN WANTED – SOUTHEAST, FL: Small animal relief veterinarian available in Broward, north Miami and south Palm Beach counties. Internship-trained. High-quality medicine and excellent client communication. Email allison@abwvet.com or call 954-361-3652. (5/18: ID#18480)

EQUIPMENT FOR SALE OR LEASE

EQUIPMENT FOR SALE – LONGWOOD, FL: 2010 Vet-Ray machine

by Sedecal for sale. Purchased new in 2010 for $18,000. Could be retrofitted for digital. Also have an automatic film developer that could go with it. Asking $10,000 obo, Please contact Shellie at 407 310-0135 or shellie@dyll.com (5/18; ID #1389)

PROPERTY/PRACTICES FOR SALE

VETERINARY CLINIC FOR LEASE – SUNRISE, FL: FOR LEASEFree standing, NEWLY renovated small animal clinic. Fully equipped with Digital X-Ray and blood machine. Excellent location on busy Commercial Blvd & Andrews Ave., close to a major highway and the beach so LOTS of exposure to the public. Rent is very reasonable and negotiable. This is an excellent opportunity at a great location! Please call Dr. Saleh at 954-483-3313 (5/18: ID#17406)

Interested in selling your practice?

FREE Practice Appraisal

NEW LISTING! SOUTH FL Located between Miami and The Keys Grossing $1mil+, Owner willing to stay on COMING SOON! MIAMI Grossing $1mil+, Ideal commercial location SOLD! PANHANDLE / 30A, FL Posh, Dream location, Grossing $750K

Practice Sales | Valuations Associate Buy-Ins

912-268-2701 | www.PracticeSalesAdvisors.com Rebecca@Practicesalesadvisors.com

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Florida & Georgia Practices for Sale FL: NEW! Orlando Area: SA prx + satellite clinic grossing $1.3M+ in 2017. RE included at both. No after-hours ER. (FL11S)

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FL: NEW! North of Orlando: 1.5 dr, SA prx. Gross $932K+ in 2017. RE included. No after-hours ER. (FL10L)

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FL: NEW! The Villages Area: $1.1M+ gross. 4.5 day work week. Major growth potential. (FL52S)

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FL: NEW! North of Jacksonville: $790K gross. 4.5 day work week. Tremendous area development. (FL65Y)

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GA: South Central GA: $818K+ gross, up 13% in 2018, 1.5 doctor practice. (GA14F)

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FL: South Central FL: $624K+ gross, solo doctor practice. No emergencies, 5 day work week. (FL28A)

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FL: North Miami: $766K+ gross, small animal, solo doctor practice. Leased facility. (FL60M)

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FL: SOLD! Jacksonville Area: Congrats to Dr. Patrick Wright in the sale of Normandy Boulevard Animal Hospital to Drs. George Khalil & Robert Medlock. (FL25J)

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1610 Frederica Road, Saint Simons Island, GA 31522 Toll Free: (800) 333-1984 | www.simmonsinc.com Email: southeast@simmonsinc.com Licensed Real Estate Broker in Florida, Georgia, North Carolina, & South Carolina

Florida & Georgia Practices for Sale FL: NEW! Orlando Area: SA prx + satellite clinic grossing Florida Practice $1.3M+ in 2017. RE included at both.Listings!

No after-hours ER. (FL11S)

Under Contract-Central Fl.– Dr. Practice 2017 FL: NEW! North of Orlando: 1.5Solo dr, SA prx.

Gross with $932K+ in gross of $860k priced to sell.

Established for(FL10L) about 40 years with great 2017. RE included.

No after-hours ER. reputation.

FL: NEW! The Villages Area: $1.1M+ gross. 4.5 day work Central Fl.– 1.5 Dr.potential.

Practice,(FL52S) beautiful hospital, well equipped. week. Major growth

2017 gross just under $1mm.

FL: NEW! North of Jacksonville: $790K gross. 4.5 day work

Florida– Very profitable weeknight and weekend emergency week. Tremendous area development.

(FL65Y) clinic. Nice hospital, well equipped 2017 gross $1.16mm GA: South Central GA: $818K+ gross, up 13% in 2018, 1.5

Sold-Central Florida– doctor practice.

(GA14F) Solo Dr. Practice in affluent area. Nice, free standing ~2800 sq. ft., 3 exam rooms. 2017 gross $580K. FL: South Central FL: $624K+ gross, solo doctor practice. No

S.W. Florida– 5 2day to work 2.5 Dr. well established Prx w/ ~3000 sq. emergencies, week.

(FL28A) ft., 3 exam rooms, well equipped and well staffed.

2017 $1.8mm.

FL:gross Northof Miami: $766K+ gross, small animal, solo doctor practice. Leased facility. (FL60M)

Are Corporate Groups contacting you about buying your Practice?

If so, let us help you make sure you get your best deal!!!

FL: SOLD! Jacksonville Area: Congrats to Dr. Patrick Wright Weofare looking for quality practices to list intoFlorida. in the sale Normandy Boulevard Animal Hospital Drs. George If Khalil your are considering selling your Practice, call us for a complimentary & Robert Medlock.

(FL25J) Consultation!!!

1610 Frederica Road, Simons Island,information.

GA 31522 Contact Dr. Richard AlkerSaint for further practice Toll Free: (800) 333-1984 | www.simmonsinc.com 850.814.9962 or Richard@tpsgsales.com Email: southeast@simmonsinc.com Licensed RealofEstate Showcase Properties CentralBroker Florida,inBroker Florida, Georgia, North Carolina, & South Carolina

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(800) 333-1984 | Southeast@simmonsinc.com | www.simmonsinc.com | 1610 Frederica Road, St. Simons Island, GA 31522