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F V M A ADVOCATE ISSUE 6 | 2020

FELINE HOUSESOILING

Lore I. Haug, DVM, MS, DACVB | Pg. 8

BOUNDARIES: PROTECTING YOURSELF AND YOUR STAFF

Candace Boudreau, CVT | Pg. 12

PAIN MANAGEMENT IN THE DENTAL PATIENT

Michael Peak, DVM, DAVDC | Pg. 22

92

THE

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FVMA ANNUAL CONFERENCE RESCHEDULED | Pg. 16


President's Message Greetings Colleagues, I hope everyone had a wonderful holiday season! It can be such a busy and eventful time of the year, but I hope you were able to take a moment, however short, to reflect on the previous year and be hopeful for the new one.

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

I found myself in an interesting circumstance last month. My daughter’s horse was in need of a lameness workup. After a conservative treatment of rest and medication did not achieve a resolution to his problem, I became “the client.”

OFFICERS

Dr. Mary Smart President Dr. Marta P. Lista President-elect Dr. Donald H. Morgan Treasurer Dr. Michael Epperson Past President

DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Thomas E. Hester District 2–Northeast Dr. Todd Fulton District 3–Central Dr. Donald S. Howell District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Robert L. Swinger District 6–South Florida Dr. Barbara Lewis District 7–Southwest Dr. John R. Wight District 8–Northwest Dr. Christine M. Storts District 9–Space Coast Dr. Ernest C. Godfrey AVMA Delegate Dr. Richard B. Williams AVMA Alternate Delegate Dr. Jacqueline S. Shellow FAEP Representative to the FVMA Executive Board Dr. Dana Nicole Zimmel Dean, Ex Officio

I had to travel to Ocala for the workup, so I carefully planned the timing of my drive. I added 30 minutes, just in case. When I arrived, I wasn't sure of the proper procedure. Could I just go into the office? Did I need to call from the car? My daughter was traveling in from Jacksonville, and I was hoping she had planned her timing carefully. Though our horse is usually well behaved, I wondered if, since he hadn’t travelled much since COVID, would he be wild and hard to handle? You get the picture. I had all “the client” thoughts going through my head—and I was a little worried too. What if he had something really bad? Despite being a veterinarian for 35 years, I was out of my element and it was a bit unsettling. It made me appreciate even more what our clients and patients go through when they come to see us. I have always said we are members of an extraordinary profession. Spending a day on the other side of the table reminded me of what each of you accomplish every day. You touch people’s lives as you care for the animals that are important to them. I would like to give a shout out to each and every one of you and your teams. Thank you for the incredible service you provide to the animals and people of Florida! Thanks to the efforts of Dr. Ernie Godfrey, Mr. Jim Naugle, and the FVMA meetings team, Cynthia Whitaker and Natalie Schol, the FVMA has launched a very successful online continuing education (CE) program. Be sure to check out FVMA LINK on the FVMA.org website to peruse the many interesting topics available—both live and on-demand! I have attended three of these meetings and each one was excellent. In other CE news, the 92nd FVMA Annual Conference has been rescheduled to July 8–11, 2021. It will take place at the same venue, the Hilton Bonnet Creek and Waldorf Astoria Hotel of Orlando. If you made room reservations for the previously scheduled March meeting, please call the hotel directly and make the needed changes. We are hopeful for an in-person conference, but our planning team will have flexible modalities for delivery of continuing education. Our amazing staff at FVMA headquarters continues to support all veterinarians in Florida. Thank you to all our staff as they continue to maintain the strength of our association. We are all looking forward to fresh beginnings in 2021. Best wishes to you, your families and your teams for a healthy new year. Gratefully yours,

Mary Smart, DVM

FVMA MISSION:

TO ADVANCE THE VETERINARY MEDICAL PROFESSION, PROMOTE ANIMAL HEALTH AND WELL-BEING, AND PROTECT PUBLIC HEALTH.

Opinions and statements expressed in The Advocate reflect the views of the contributors and do not represent the official policy of the Florida Veterinary Medical Association, unless so stated. Placement of an advertisement does not represent the FVMA’s endorsement of the product or service.

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FVMA Executive Board Suspends FVMA Elections for 2021 During a meeting on September 30, 2020, the FVMA Board of Governors recommended that the FVMA Executive Board adopt a resolution to suspend elections for directors and officers for 2021 and to resume with the next regular election process under Articles XII and XVI of the FVMA Bylaws in 2022. The FVMA Board of Governors recommended that the FVMA Executive Board adopt the following resolution: Resolved, that due to the current COVID-19 pandemic and the sudden passing of the FVMA Executive Director Mr. Philip Hinkle, the FVMA Executive Board, in an effort to maintain the necessary purposes for which the association is organized, allow all current officers of the organization to serve in their current capacity until the 2022 Annual Meeting. Seeing as Dr. Mary Smart will be unable to serve as president past this current term, the executive board will replace her position as president in March of 2021 with recent past president Dr. Richard Sutliff. This will help to provide the experience and leadership needed to transition us through this next year and our search for a new executive director. Dr. Marta Lista will remain as president-elect for 2021 and become president in 2022. Dr. Mary Smart will assume the position of immediate past president for both the 2021 and 2022 terms. By unanimous approval of the FVMA Executive Board, the next regular election process under Articles XII and XVI of the FVMA Bylaws will be held in 2022. All the current officers on the board up to the president-elect position will retain their elected positions until 2022. This transition will occur in March of 2021 to coincide with the originally scheduled dates of the FVMA annual conference. Dr. Mary Smart will transition to past president of the association in 2021. At that time, Past President Dr. Richard Sutliff will assume the position of president in 2021 for one year. Past President Sutliff previously served as president of the FVMA in 2016. The FVMA Board of Governors believes that these changes, which were endorsed and approved by the FVMA Executive Board, will ensure the stability and leadership of the FVMA as the organization transitions through the next year and conducts a search for a new executive director.

In This Issue 4 | 6 | 8 | 12 |

Obituaries Member Spotlight Feline Housesoiling Boundaries: Protecting Yourself and Your Staff 15 | FVMA Membership Offerings

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16 | 92nd FVMA Annual Conference Rescheduled 18 | COVID-19 Legislation Update 19 | FVMA LINK 20 | FVMA 2021 Annual Operating Budget 22 | Pain Management in the Dental Patient 26 | Practice Pulse 28 | Classified Advertisements

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Lisa Conti, DVM

In Remembrance

Dr. Lisa Conti lost her battle with cancer on November 6, 2020. Dr. Lisa Conti served on the National Institutes of Health National Advisory Environmental Health Sciences Council, was an adjunct professor at Florida State University, courtesy associate professor at the University of Florida College of Veterinary Medicine, and has taught at Tallahassee Community College. She was also an affiliate with Yale University School of Medicine on human-animal medicine projects. Dr. Conti attended the University of Miami for chemistry and math before applying to the University of Florida to study veterinary medicine. In 1988, she started at the Florida Department of Health (FDOH), first with the AIDs surveillance section. She then worked as a state veterinarian, where she fielded questions about pet ownership and the immunocompromised and developed guidance for patients to keep their pets. During this time, she was invited to attend the International AIDS Conference, where she heard one speaker from Africa state, "If the cure for AIDS right now is just clean water—I could not give that to my people." This prompted Dr. Conti to earn a master's in public health from the University of South Florida and focus on environmental health.

At FDOH, she was promoted to division director of environmental health. She founded the Association of State and Territorial Health Officers' State Environmental Health Directors group to work on a myriad of public health issues. After 23 years at FDOH, Dr. Conti went to the Department of Agriculture and Consumer Services. She was the first chief science officer (CSO) as well as deputy commissioner under Adam Putnam. Under Commissioner Nikki Fried, Dr. Conti served as CSO and director of strategic initiatives, with interests in agricultural innovation. She was also prominent in the One Health movement. As a One Health representative, she traveled widely, working with an international community devoted to the area of human-animal medicine. Dr. Conti wrote and co-authored numerous articles on One Health, public health, HIV/AIDS surveillance, and vector-borne and zoonotic disease topics. Recognized nationally and internationally for her work, she received the American Veterinary Epidemiology Society Gold Head Cane Award, Florida Public Health Woman of the Year Award and the American Veterinary Medical Association's Public Service Award. Dr. Conti loved clinical medicine and worked Saturdays at the Capital Circle Veterinary Hospital for almost 30 years. She was also board certified in preventive medicine through the American College of Veterinary Preventive Medicine. Dr. Conti is survived by her husband of 31 years, Thomas Seal; their son, Dane Conti Seal; brother, Dan Conti; and numerous loving family members.

Fred Hall, VMD Dr. Fred Hall, 81, passed away from COVID-19 on October 12, 2020. In 1968, he moved to Orlando, Florida, with his wife Sandy Hall and established Powers Drive Animal Hospital. In his practice, he worked tirelessly. He showed up early to clean sidewalks outside the building and often did not charge clients who could not afford to pay their vet bill. Dr. Hall attended Rutgers University for his undergraduate degree before applying to the University of Pennsylvania to study veterinary medicine. Out of about 300 applicants, Dr. Hall was one of about 60 who were accepted. A heartwarming community man, Dr. Hall was well known for sitting in his open garage, working on heirloom tackleboxes and homemade wooden fishing lures, and chatting (sometimes for hours) with friends and acquaintances who stopped by to say hello. He was well-known for his many kind acts, whether picking up the 4  |  FVMA ADVOCATE

bill for a friend he recognized when out to dinner, helping to run the youth ministry at church or donating a car when a local women’s shelter needed a way to transport women to appointments. Dr. Hall also recognized how important pets are to older adults, particularly those whose spouses recently died. He would always make a point to call the grieving spouse, check in and offer help. Dr. Hall is survived by his wife of 57 years, Sandy Hall, his daughter, grandchildren and their close friends.


Robert Jackson, DVM | FVMA Past President (1978) On November 3, 2020, FVMA Past President Dr. Robert Jackson passed away at the age of 85. Born and raised in Lakeland, Florida, he graduated from Lakeland High School in 1952. He received his bachelor’s in animal science from the University of Florida (UF), where he was a member of the ATO fraternity. While at UF, Bob met and married the love of his life and wife of 60 years, Patricia Shefler. Dr. Jackson then attended Auburn University, where he received his DVM and graduated first in his class. After graduation, he relocated to Jacksonville, Florida, where he owned and operated Parkway Animal Hospital for 45 years. In 1978, he served as president of the Florida Veterinary Medical

Association and was honored to preside over the opening of the UF College of Veterinary Medicine. In 2000, he was awarded the lifetime achievement award by the FVMA. Dr. Jackson was known as a kind and humble family man who always smiled and lent a helping hand. He loved his time on the water and was an active member of the Captain's Club for many years. He and his wife, Pat, had many adventures on the St. Johns River. He was a lifelong Gator fan and spent many a Saturday at The Swamp. He loved golfing, fishing, hunting, and, in his later years, spending time on his dock with family and friends. Dr. Jackson was known as a devoted and passionate practitioner who gave his all. He is survived by his children: Robert Jackson, Kim Meade (Gene), Dr. Ronald Jackson (Sherry), and Tracy Lovett (Steve), as well as his grandchildren, Zachary, Jacob, Alexis, Colton, Kaylyn, Gabrielle, and Tyler.

Jerry Holmes Johnson, DVM, MS, DACVS, CVA Dr. Johnson of Lexington, Kentucky, and Hollywood, Florida, passed away at the age of 81 on November 9, 2020. He attended the University of Georgia where he earned his undergraduate and veterinary degrees. He also served seven years in the U.S. Army Reserves and was honorably discharged in 1963 with the rank of Staff Sergeant. After his graduation, he entered academia and became a diplomate of the American College of Veterinary Surgeons (ACVS). As a boarded surgeon, he taught equine surgery for 16 years at the University of Pennsylvania New Bolton Center, Iowa State University (MS), Kansas State University, Auburn University and the University of Missouri. Over the course of his career, Dr. Johnson became known as a pioneer in equine veterinary medicine. A close friend of Dr. Alex Harthill, during the 1970's, they worked closely together in Louisville on numerous occasions to test various medical and technological innovations. In the 1970s, he also cared for Grand Prix jumpers and many high-level Thoroughbred athletes, including Bold Ruler, Unbridled, Cigar, Fantastic Light and Tepin. Through Dr. Harthill, Dr. Johnson has been credited with introducing what is now known as Lasix (furosemide) to prevent pulmonary bleeding in Thoroughbred racehorses. In 1979, Dr. Johnson entered private practice in Lexington, Kentucky. He focused on Thoroughbred racehorses and related surgeries, including arthroscopic and laser procedures. His expertise in equine laser surgery of the throat is recognized throughout North America. From the early 1970's to 2019, Dr. Johnson worked tirelessly to convince Tennessee Walking Horse connections to eliminate the practice of "soring.” He also conducted field trial studies for many pharmaceutical companies and served on the KY Equine Drug Research Council. His work even helped develop a new treatment for ulcers, now

known as Merial's GastroGard. Licensed in numerous states, he served on arbitration panels for Thoroughbred auction companies and, for 40 years, he also practiced in Jamaica and advised their Thoroughbred industry. In 2001, he spent a month in Dubai and headed up the veterinary team in charge of quarantine for the Dubai World Cup. Dr. Johnson lectured around the globe, authored chapters in veterinary textbooks, and had articles published in the American Association of Equine Practitioners Proceedings, Journal of the American Veterinary Medical Association, and Journal of Equine Medicine. He was a member of the AVMA, AAEP, ACVS, NAARV, KVMA, KAEP, FAEP, The Thoroughbred Club and The Keeneland Club. Dr. Johnson is survived by his wife, Patricia White Johnson; daughters, Julee Johnson and Kaitlyn Hildenbrand (Maury); longtime friend, Jo Ann Johnson; sister-in-law, Barbara White Crockett; nieces, Jennifer Knight (Mark) and Elizabeth Erickson (Nils) (daughters of his late sister-in-law, Jacqueline White), nephew, Major Roy B. Crockett; USMC (Anais); adopted daughter Elizabeth Connolly (Jim); and grandchildren, Juel, Ty, Alexa, Ashley, Christopher, and John. He left behind his beloved dog Bella, his rescue Thoroughbreds, his catfish pond, several John Deere tractors and over 200 John Deere toys.

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MEMBER SPOTLIGHT A FIGHTING SPIRIT:

Dr. Ali Coan and Her Inspiring Pitbull, Bunny On April 15, 2020, a 13-week-old puppy was rushed into Desoto Animal Clinic. The puppy’s legs stuck straight out, her head was arched back, and her ears were pinned up together on the top of her head. Her mouth was tautly stretched in a sardonic grin— and she couldn’t move at all, even with force. When presented with this statue-stiff puppy, FVMA member Dr. Ali Coan knew exactly what she was dealing with. “When I first saw Bunny, I had just walked out of a sad euthanasia of a nine-year-old dog,” Dr. Coan said. “The sight of her made me sick to my stomach. She was hard to look at and I knew her prognosis could be poor considering how advanced her clinical signs were. Even though we all do this for a living, I am not completely immune to watching an animal suffer through such harsh states of trauma and pain. Immediately, I thought that this was a case of tetanus so I started to move as quickly as I could based on that tentative diagnosis.” As the owner of the puppy began to discuss euthanasia options, Dr. Coan came up with another plan to give the pup a fighting chance. She asked that the puppy be turned over to her for constant care, and the owner, thankfully, agreed. “I wanted to give Bunny a chance even though I had never seen, much less treated a dog with tetanus. When I looked into her eyes, there was that connection and I knew she wanted help and to live,” Dr. Coan said. “I am a childhood cancer survivor and overcoming such a grave prognosis influences the way I view my patients. I want to give them the chance at life that I had. Being a pitbull, I knew that her strong breed would be a strength in her case and, that if any young puppy could pull off a miracle, it would be a pup like her.” The first two weeks were brutal. Bunny, as the puppy was now called, needed minute-to-minute care; a task taken on by both

The classical saw-horse body position seen in severe Tetanus cases. Bunny’s body remained in this state for a full 20 days. Image courtesy of Dr. Ali Coan. 6  |  FVMA ADVOCATE

A healthier Bunny and Dr. Coan weeks after her recovery. Image courtesy of Kim Klement. Dr. Coan and her husband, Matt. They kept Bunny sheltered in a dark, quiet room with a sleep mask over her eyes to help her avoid stimuli, decreasing stress and, therefore, avoiding some of the muscle spasms and dramatic seizure-like activity that occur with tetanus. Bunny received IV fluids, IV antibiotics, IV anti-seizure meds, IV sedatives, IV muscle relaxants and was fed through a syringe since her jaw was locked shut. She also required continual hygiene care to keep her immobile body clean. Dr. Coan also used ice and heat therapy along with range of motion and physical therapy exercises to help recover Bunny’s muscle memory, tone and strength. After about three weeks, there were small signs of improvement—a slightly raised head, a tail wag. After 21 days of intensive care, Bunny took her first unassisted steps. A huge milestone—and the first of many steps to come. Bunny is now fully recovered and lives the active, energetic lifestyle of a healthy puppy.

Dr. Coan soothing Bunny after performing late-night nursing care. Image courtesy of Dr. Ali Coan.

One of many daily syringe feedings. A task that required a lot of patience and attention to help ensure no aspiration occurred. Image courtesy of Dr. Ali Coan.


Physical therapy for Bunny included massage, muscle compression, range of motion, and strength and muscle memory exercises as seen here. Image courtesy of Dr. Ali Coan.

A fully restored Bunny enjoying a boat day on the Gulf of Mexico off of Anna Maria Island. Image courtesy of Dr. Ali Coan.

“After Bunny survived the first seven days, I knew tetanus wasn’t going to take her,” Dr. Coan said. “I kept hoping, praying and working on preventing any of the other secondary complications from occurring—pneumonia, cardiac failure, herniations. By the end of week two, I knew she was going to survive but we were exhausted and ready to have her up and moving. Sometime during week three, she really began to show great improvements in her strength, and we knew we were getting closer to reaching the goal line of her recovery. On day 21, I got home from work and Matt had Bunny out in the front yard. Just as I got out of my car, Matt put Bunny down onto her four awkward feet and she immediately took off towards me—all on her own! She was so proud, and it was the cutest thing to watch her still-stiff body doing its best to zoom through the grass. That was the first and only time I allowed myself to cry over her. I was completely overjoyed and beaming with pride. In that moment, all of the prior pain and stress went away. It was a special moment—one I’ll always remember.”

Dr. Coan and Bunny enjoying a stroll in their Florida neighborhood. Image courtesy of Kim Klement.

undue suffering through euthanasia when relief is not possible— these are the things that make me proud to be a part of our great profession.” Dr. Coan grew up in Bradenton, Florida. She received her bachelor’s degree from the University of Florida and graduated from Ross University School of Veterinary Medicine in 2015. She spent her final clinical and surgical year at the University of Florida in 2014-2015. After receiving her degree, she returned home to Bradenton and began working at Desoto Animal Clinic— an exciting opportunity to serve her hometown community. She and her husband, Matt, enjoy Gator football, spending time with family and friends, and being outdoors, especially on the water. They have three rescue dogs (Cooper, Tibby, Bunny) and a rescue kitty, Leo.

In all her years as a vet, Bunny’s was the most involved, intensive case that Dr. Coan says she has ever dealt with. Now that Bunny is healthy, the public’s immense support of Bunny’s story serves as a reminder that Dr. Coan did the right thing in choosing to fight for her. “Bunny’s story sums up exactly why I do what I do, and why I give such a large portion of my life to veterinary medicine,” Dr. Coan said. “I know hers is just one of thousands and that many do not have a fairytale ending, but it’s cases like hers that pick me up and give me hope for every sick patient that comes through the door. To give an animal a chance at life that they might not have had, to offer healing through treatment and even to prevent A not-camera shy Bunny posing for a photo at her home. Image courtesy of Kim Klement.

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FELINE HOUSESOILING Lore I. Haug, DVM, MS, DACVB Feline housesoiling still represents one of the most common reasons cat owners seek behavioral advice from veterinarians and behaviorists. Housesoiling can be seen in all ages and breeds of cats and can often be frustrating to resolve. The causes are multiple and often complex. Many litterbox problems can be prevented by establishing good litterbox habits when the cat is young and also by educating the owner on good litterbox management. Kittens should be confined in small areas (cage, bathroom, bedroom, etc.) while they are learning to find and use the litterbox. Close proximity of the box will encourage usage. If young kittens stray too far from the box, they may be unable to find the box or reach it quickly enough once the urge to eliminate occurs. Kittens gradually can be given more freedom as they grow and learn the layout of the house. Litterboxes for kittens should be large enough to allow the animal to maneuver inside the box, yet shallow enough for the kitten to easily jump inside. The owner may need to purchase subsequently larger boxes as the kitten grows.

Litterbox Management Size, location, litter choice and hygiene are important aspects of good litterbox management. Boxes need to be large enough to allow the cat to comfortably enter and maneuver inside. Commercial

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Photos from Shutterstock

litterboxes are often too small for many cats, especially some of the larger designer breeds such as Savannahs. Large plastic storage boxes make excellent alternatives for cats. They are economical and can be purchased in a variety of sizes. The boxes can remain covered or the owner can use a tall-sided box with an open top. Additionally, a door can be cut into the box to suit each individual family’s need. The litterbox should be located in a relatively private area that is easily accessible to the cat and blocked away from dogs or children. Litter should be chosen to appeal to the cat, not the owner. Most cats prefer fine grain type clumping litters. Cats have individual preferences for litter odor. Ideally owners should provide the cat initially with some litter choices to allow the cat to indicate its preferred litter. Any change in litter type should be done gradually over a span of one to two weeks. Multiple litterboxes should be available in multi-cat households. In general, there should be one litterbox per cat plus at least one extra. The more cats that are in the household, the more extra boxes that should be present. These boxes should be distributed in multiple locations and not situated close together or in the same room. In multistory homes, there should be a litterbox located on each floor even if only one cat resides in the house.


Litterboxes should be scooped a minimum of one to two times per day. Some extremely fastidious cats will only use a completely clean box. Litter needs to be completely changed on a regular basis, even if the owner is using a scoopable litter. Scoopable litters are usually changed every two to four weeks, whereas non-clumping litters should be changed at least once per week. Litterboxes should also be cleaned on a regular basis; the frequency will depend on litter type and the number of cats using the box. Litterboxes should be washed with warm water and soap. Owners should avoid disinfectants. If residual odor is a problem, the owner can soak the box in an enzymatic odor neutralizer such as Outright®, AntiIcky Poo® or a molecular odor neutralizing product such as Zero Odor®. Litterboxes should be replaced every few years or more frequently if residual odor is apparent.

Diagnosis

A detailed history is critical for accurate diagnosis. Information should be acquired about the nature of the problem (e.g. urine, feces or both), current and past litterbox management, the animal’s environment, and social issues. Many clients have made changes attempting to resolve the problem and this information is important as well.

Inappropriate Elimination

It is helpful to have the client give a chronological account of the problem as this provides information on the onset, duration and progression of the inappropriate elimination. Clients should also be encouraged to draw diagrams of their house, indicating soiled areas, furniture, windows, doors, location of the litterboxes, location of food and water bowls, and the areas where the cats spend most of their time. These diagrams are immensely useful, and often essential, in determining diagnosis and treatment.

Inappropriate elimination can occur in any age, sex or breed of cat; however, Persians, Himalayans and related breeds may be predisposed to housesoiling problems. The problem may manifest as housesoiling (urine and/or feces), horizontal urine marking, and/or urine spraying. Fecal marking appears to be much less common than urine marking.

The critical step in the diagnostic process is to differentiate housesoiling (a toileting problem) from marking behavior. An inability to or lack of attempt to differentiate these problems (and thus get an accurate diagnosis) is one of the major reasons for treatment failure. This distinction is also necessary to determine if pharmacological intervention is appropriate or not.

All cases of inappropriate elimination should receive a thorough medical evaluation. Urinalysis and/or fecal examination should be done with every case. Additional diagnostics are often indicated including imaging and blood chemistries Practitioners should be particularly suspicious of medical issues in senior cats and when cats with previously good litter box habits abruptly begin housesoiling. Declawing surgery is a common trigger for inappropriate elimination in young cats. Interstitial cystitis is often associated with truly random and frequent inappropriate urination throughout the house, and the problem may appear cyclical.

Differential classifications for housesoiling include inadequate housetraining, inadequate access to appropriate elimination areas, litter/box aversion, substrate preferences or aversions, and location preferences or aversions. Inadequate access may be due to physical, environmental or behavioral constraints. For example, an elderly cat may have to climb stairs or over a gate to get to the litterbox, or the litterbox may be located near the washing machine of which the cat is afraid. Alternatively, in a multi-cat household, one cat may be overtly or subtly preventing another cat from accessing the litterbox area.

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The likelihood of urine marking increases with increasing population density in the home. By far, the majority of cases of urine spraying in multicat households are driven by social strife. So, in multi-cat households, careful attention should be paid to the social relationships between each pair of cats. Owners often have difficulty identifying covert aggression in cats. Owners should be questioned closely about the cats’ body postures and reactions to each other under various contexts. Use diagrams of cat body language and/or have the owner videotape the cats to better delineate any potential problems. Urine marking is often associated with variable levels of stress and anxiety, which is why these cases often benefit from adjunctive drug therapy. Accurate identification of the triggering stimuli is important for successful therapy.

Treatment Substrate preferences are common in cats and often arise as a secondary problem to another inciting cause (e.g. a bout of cystitis that drives the cat out of the litterbox). Cats prefer soft, absorbent surfaces and will frequently eliminate on bathmats, bedspreads, laundry and carpet. Litterbox or substrate aversions are also common. Dirty litterboxes are a common cause of housesoiling. Medical issues that create discomfort when the cat eliminates also can trigger litterbox or substrate aversions. The cat may associate this discomfort with the litterbox and elect to try eliminating elsewhere. When cats eliminate directly outside the litterbox, this is almost always an indication that the cat has some issue with the box or the litter. Other clues include the cat trying to stand on the edge of the litterbox or showing reluctance to enter or remain inside the box. Cats may also be reluctant to actually scratch in the litter before or after eliminating. Location preferences may be primary or secondary problems. The cat usually chooses one or two select areas in the house. Location aversions are typically related to environmental stimuli in close proximity to the box (e.g. appliances, a dog crate, doorways). The cat may eliminate indiscriminately in several other areas or choose one to two specific locations. These locations are often in low traffic areas in the house such as the dining room or a spare bedroom. Marking behavior may be manifested by deposition of urine on horizontal surfaces or by spraying on vertical surfaces (and less commonly by deposition of feces). Triggering stimuli are associated with territorial, social and environmental (stress) issues. Some cats urine spray in response to strong odors such as dirty laundry. Urine marking is not always about territory or dominance; sometimes it’s just a piece of information with no ulterior motive— “I was here, and this is interesting.” Some cats also urine spray or phantom spray associated with arousal such as when the owner returns home. Nevertheless, urine marking does frequently relate to a specific issue in the home. Urine marking is typically a reaction to social triggers (animals, humans, separation) or environmental triggers (olfactory, visual, new items in the house).

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Treatment focuses on preventing the animal’s access to stimuli that trigger the inappropriate behavior while concurrently establishing more appropriate litterbox habits. The owner should prevent the cat from having access to previously soiled areas. In the case of surface preferences, the cat must be kept away from the preferred surface. In most cases, this means confining the cat in some fashion–in a bedroom, bathroom or cat cage for example–depending on the distribution of the problem. Soiled areas should be thoroughly deodorized with an enzymatic or molecular odor neutralizer to reduce the cat’s attraction to the area. The owner should be assisted in correcting any deficiencies in litterbox management. Litterbox and substrate aversions are resolved by taking steps to make the box more attractive to the cat. The cat should be confined with two to three litterboxes, which are manipulated to provide the cat with a preference test. One box should be identical to the cat’s regular box. The other two boxes are each changed in only one way. For example, if the regular box is uncovered, one new box may be covered with the cat’s regular litter while the other may be uncovered with a novel litter. The owner is instructed to keep a journal documenting the eliminations that occur in each box over the subsequent seven days. Once a pattern of preference is noted, the preferred box is kept unchanged and one change is made to each of the other two boxes. This process is repeated until the owner has identified a litterbox arrangement that the cat consistently prefers over all others offered. Owners should be forewarned that they should cycle through several litters and not stop after trying just one or two. Examples include: recycled newspaper, clumping wheat or corn litter, play sand, wood chips, regular clay litter, topsoil (very useful for cats making a transition from outdoors to indoors), crystals, pearl litters, and non-disposable diapers or carpet remnants (for cats with carpet surface preferences). Environmental stresses can often be controlled with management and preemptive steps such as using Feliway for several days before owners travel or spraying the product on new items that will be brought into the house. New items in the house can also be confined in an area where the cat cannot go until the item has been in the house long enough to lose most of its novel odor.


In multi-cat homes, encouraging the cats to show behavioral separation can reduce social stress. All resources should be spread throughout the house. There should be multiple locations for food, water, litterboxes and favored resting areas widely distributed throughout the home. When severe social stresses are present (e.g. intra-or interspecies aggression), these must be addressed using a desensitization/counterconditioning program. Drug therapy is helpful and often necessary when social or environmental stressors are involved and they cannot be removed or effectively modified. It offers almost no benefit for cats that have location, substrate, or litterbox issues and should not be used for these issues. Psychopharmacological agents should not be used frivolously. Clear indications should be present and the practitioner should evaluate the benefits in relation to risk of drug interactions, complications for existing medical conditions, drug side effects and the cost to the owner. Additionally, the practitioner should remember that all psychotropic medications are of extralabel use in cats.

elimination disorders. Fluoxetine is dosed at 0.5 –1.0 mg/kg QD, paroxetine at 0.25 – 1.0 mg/kg QD and sertraline 0.5-2.0 mg/ kg QD. I typically recommend starting at the lower dosages and evaluating the cat’s response in two to four weeks. Buspirone is a partial serotonin agonist. It is dosed at 1 mg/kg BID or 2.5-5mg per cat BID. This drug has demonstrated equal efficacy to diazepam for control of urine spraying. Both SSRIs and buspirone are relatively void of side effects, although some animals may demonstrate agitation or hallucinogenic-like behavior on buspirone. Venlafaxine, a serotonin-norepinephrine reuptake inhibitor has shown promise in a pilot study for reducing inappropriate elimination particularly in cats with feline interstitial cystitis. Unfortunately, to date, studies indicate a high relapse rate for urine spraying once drug therapy is withdrawn, particularly if owners are unwilling or unable to sufficiently alter the cat’s environment to correct the underlying problems long term.

Historically, diazepam and progestins were used most commonly for treatment of urine marking and spraying. Progestins produce non-specific effects and can be associated with a wide range of serious side effects. For these reasons, these drugs are no longer recommended. Benzodiazepines act rapidly and are economical as well as effective; however, they should be used with caution in cats due to the risk of idiosyncratic hepatic necrosis. Due to the number of other pharmacological options now available, these are usually not recommended as first lines of treatment. Serotonin modulators represent the newest group of drugs available to assist in treatment of anxiety-related elimination disorders. These fall into three broad categories tricyclic antidepressants (amitriptyline, clomipramine), selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline), and atypical antidepressants (buspirone). Tricyclic antidepressants (TCA’s) modulate levels of both serotonin and norepinephrine to varying degrees. They also have antihistaminic and anticholinergic effects and these latter properties account for most of the side effects. Amitriptyline (1 mg/kg BID) may be effective due to its potential positive effects on neurogenic pain associated with interstitial cystitis. Its onset of action is slightly more rapid than that of clomipramine. Hoover, amitriptyline frequently creates unacceptable lethargy and also relatively high incidents of increased irritability. This author rarely uses this medication in cats. Clomipramine is more selective for serotonin effects and has less antihistaminic properties than many other TCA's, so clients often see less sedation. Clomipramine is dosed at 0.5-1.0 mg/kg QD in cats and has relatively high efficacy for reducing urine spraying and aggression. Clomipramine should be avoided in senior cats due to its potential cardiac side effects and ability to reduce cognitive function.

Lore I. Haug, DVM, MS, DACVB Dr. Lore Haug graduated summa cum laude from Texas A&M College of Veterinary Medicine in 1993. She did a one-year rotating internship at the Louisiana State University School of Veterinary Medicine before returning to Houston in a general practice. Dr. Haug worked in general medicine and emergency medicine until 1999, when she returned to Texas A&M to complete a residency and master’s degree in behavioral medicine. After her residency, she remained on faculty at Texas A&M, running the Animal Behavior Service until 2007. She then returned to the Houston area to work in a private referral practice doing exclusively behavioral medicine. Dr. Haug currently sees behavior cases at Texas Veterinary Behavior Services in Sugar Land, Texas. She is a past president of the American College of Veterinary Behaviorists, a member of the American Veterinary Medical Association, a certified animal behavior consultant through the International Association of Animal Behavior Consultants, and a member of the Association of Professional Dog Trainers and the American Veterinary Society of Animal Behavior. Dr. Haug has a special interest in neurobiology, learning principles and pharmacology. Dr. Haug is a frequent speaker at veterinary and behavior conferences. She also writes for a number of industry publications. She is an active equestrian and shares her home with her husband, a pit bull-mix dog and an Arabian gelding.

Fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) represent SSRIs commonly used for adjunctive therapy in WWW.FVMA.ORG |

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BOUNDARIES f f a t S r u o Y d n a f l e s r u o Y g Protectin Candace Boudreau, CVT

Photos from Shutterstock | Icon from Nounproject

Self-care has become a popular topic, a buzz word we’ve heard so often that it fades into the background—but what does self-care actually look like? The first image that comes to mind may be of someone enjoying the solitude of quiet meditation or laughing with a group of friends. However, self-care isn’t strictly yoga and staff pizza parties; it can be the things we know we should do for ourselves that we put off. It can be paying bills or buying healthy food from the grocery store. It can be declining a social invitation so you can stay home and catch up on rest. Self-care could be visiting the gym for a workout or sending the kids to Grandma’s house for the weekend. It can be having the difficult conversations. Saying, “I’m sorry, I can’t help you with that,” or “I’m not comfortable with this.” Self-care can look different for different people and depending on context. I feel confident assuming that anyone reading this already knows that compassion fatigue and burnout are ongoing challenges in veterinary medicine. I’ll go out on a limb and say that many of us in this field struggle with self-care and work-life balance, myself included. In the past few years, I’ve made a particular effort to develop a healthier lifestyle for myself, both professionally and personally. In doing so, I realized I lacked boundaries. I needed to learn how to set them and how to deal with the guilt that comes along with that. For those in the veterinary community, self-care can largely come in the form of setting boundaries.

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Boundaries in Veterinary Medicine When you think about it, we already operate within the guidelines of boundaries every day. Doctors don’t offer treatment without a doctor-patient relationship. Veterinary technicians can’t diagnose or prescribe. Pre-anesthetic blood work is required for surgery, etc. These protocols that we follow are all examples of boundaries that we set and/or maintain in every day practice. It may feel easier to enforce boundaries that are set by others. If those are the rules as they were told to us, and since we don’t make them—we just follow them, then we may feel less of a responsibility to those who are upset by


them. However, when we are setting our own boundaries, we could be more likely to internalize that guilt when the client is upset. We may also be more likely to bend our own rules, because there is no higher authority for us to answer to. When comes to dealing with burnout, I imagine the Snickers’ commercials that say: “You’re not you when you’re hungry.” You’re not you when you’re burned out. You’re not you when you keep pushing yourself beyond your limits. I know it’s tempting because you want to help as many pets as you can, but you also need time to recharge. Look at quality as well as quantity: You may see 40 pets in a day, but were you able to spend adequate time with each of them? Did you feel like you were functioning at your highest level? Or were you fatigued, rushed, just pushing yourself through to get to the end of the day? The truth is you need to take care of yourself in order to effectively care for others. Time to rest, relax and recharge is vital to not only your well-being but also your ability to function. Veterinary professionals may be superheroes, but even superheroes need to take a break sometimes. Superman isn’t always Superman, sometimes he’s just Clark Kent.

Setting Boundaries: Don’t Be Afraid An important realization for me, in regards to boundaries, was the understanding that it is not my responsibility to manage other people’s emotions. In fact, I couldn’t even if I tried. In the past, my

ability (or willingness) to set boundaries was crippled by a fear of others’ reactions. I didn’t want to hurt them; I didn’t want to make them unhappy. I didn’t want to be viewed as cruel or uncaring. The truth is those people who push back against your boundaries are often the people you need to protect yourself from the most. This realization can be difficult but also freeing. The only emotions that belong to me are my own and the only reactions to emotions that I can control are my own. It is not my responsibility to bend my boundaries for the sake of others. If you lose business because you won’t accommodate someone beyond what you are comfortable with, chances are they’re doing you a favor. I was once given the advice that you “teach people how to treat you,” meaning that what we accept from others—or where we draw the line with them—gives them an idea of how we will respond to things in the future; what their dynamic with us will be. This can be applied to relationships in both personal and professional settings. We learn new things from our experiences all the time, adding new information to our schemas that color how we see the world. Our interactions with others also teach us a great deal about how to behave. If someone in your life feels that they can be demanding of your time and resources, there is a good chance they will continue to do so. For example, that client who walks in without an appointment time again and again. Each time, they watched you go beyond reasonable accommodations to fit them in. To them, if it worked the first time, it will work the second time, and the third time, and so on. When someone is abusive to your staff and gets away with it, it’s only a matter

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of time before it happens again. You can be kind and compassionate, while still saying “no” and drawing the line in the sand.

Recognizing Your Own Value Another hard pill to swallow is the fact that self-worth should not be based on the ability to do for others. I love going above and beyond for others. I can admit to having something deep down inside of me that lights up when I know I’m truly helping someone, and I often assign value to myself based around my ability to do so. I strive to improve the lives of the humans and animals around me, and when I’m able to gain that sense of accomplishment, I’m floating in the clouds. However, the yin to this yang is that when I don’t help someone, I can easily feel like a failure and even a “bad” person. I have recognized this and started working toward a healthier self-image. One where I have inherent value as a person, regardless of what I do or don’t do for others. Every person has value (yes, even you). You are made standard with this value, it’s not an upgrade; it is part of you. Nobody should have to bend over backwards for others in order to earn it. No one is obligated to be available 24 hours a day, seven days a week, to anybody. Sure, you could try… but it isn’t sustainable. Nobody can keep that up forever without serious negative repercussions. Being nice is not synonymous with being passive and it doesn’t have to mean that you never assert yourself. Part of knowing your value is remembering that you have the right to stand up for yourself and say when you’re not comfortable with something. When you realize your value, you can then begin to trust yourself. Remember when I talked about boundaries sometimes being easier to maintain when they belong to someone else? One component of that may be a lack of trust in ourselves and our own judgement. When you trust yourself, you can try to listen to what your mind and body are asking for. When you’re feeling run down, trust that you need rest. When you’re feeling taken advantage of, trust that those

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feelings are rooted in reality. When you’re feeling uncomfortable with a situation, trust that your concern is valid and setting a boundary that you are comfortable with is the right thing to do. We are all different people with different opinions and different levels of comfort. Because of this, it would be nearly impossible to establish one standard set of boundaries and apply them to everyone. You know yourself best. Trust that your needs are legitimate. Your own unique boundaries are just as important as anyone else’s.

Self-care Is Not Selfish I know these concepts may be simple, but sometimes the simplest concepts are the most difficult to put into practice. When you find yourself struggling, as I often do, try to remember that taking care of yourself is not selfish—and it isn’t cruel. You deserve a healthy work-life balance and you deserve to put yourself first. If you take the same compassion you afford to others and turn it inwards towards yourself, you just might change your whole world. In the words of my favorite podcaster, marriage and family therapist, Dr. Kirk Honda, “take care of yourselves because you deserve it, you really, really do.”

Candace Boudreau, CVT Candace is a graduate of the veterinary technology program at St. Petersburg College in Florida and is a certified veterinary technician in the Tampa Bay Area. She also holds a bachelor’s degree in psychology from the University of South Florida, St. Petersburg. Candace is a member of the Florida Veterinary Medical Association’s Professional Wellness & Wellbeing Committee and is QPR certified in suicide prevention. In her free time, she enjoys writing, cooking, traveling and changing song lyrics to make the song about her dog, Sadie.


Did you know

FVMA OFFERS MEMBERSHIP FOR YOUR ENTIRE VETERINARY PRACTICE? Veterinary Practice Managers (VPM) In addition to veterinary memberships, the FVMA also offers memberships for your entire veterinary care team. We certify veterinary assistants and technicians to become Certified Veterinary Assistants and Certified Veterinary Technicians. We also offer membership to Veterinary Practice Managers and Animal Care Technicians. Learn more about how the members of your team can become members of the FVMA and enjoy the benefits of membership.

Prerequisites: • Verification of on-the-job training by a licensed veterinarian. • Serving a veterinary clinic as an office administrator, financial manager, etc. • $55 dues fee required every two years. Current expiration: 12/31/2023

Animal Care Technicians (ACT) Prerequisites: • Verification of on-the-job training by a licensed veterinarian. • Veterinary team member who has worked in the capacity of a technician for at least three years. • Any graduate of an AVMA-accredited veterinary technology program who does not qualify for a technician certification. • $35 dues fee required every two years. Current expiration: 12/31/2023

Certified Veterinary Assistants (CVA)

Find all the information on these memberships on the FVMA website: www.fvma.org/team-members/ To add your veterinary practice team member to the FVMA, contact us today at 407.851.3862 or email us at info@fvma.org for more information.

Prerequisites: • Complete at least nine months of an ACT approved high school or adult learning program. • Complete the “Skills Competency Validation Checklist” under the supervision of a licensed DVM, CVT and/or approved veterinary assistant instructor (VAI) where applicable. • Complete a minimum of 500 hours of practical veterinary assisting experience. • At least 250 hours must be in a veterinary hospital setting working with live animals. • Up to 250 hours can be school lab time, defined as non-lecture time, wherein the student applicant performs and appropriately utilizes related veterinary assisting skills under the supervision of the VAI. • Score 70% or higher on the CVA Final Exam. • $25 dues fee required every year. Current expiration: 12/31/2021

Certified Veterinary Technicians (CVT) Prerequisites: • Graduate from an AVMA-accredited veterinary technician program. • Obtain a passing grade in the Veterinary Technician National Exam (VTNE), which is administered by the American Association of Veterinary State Boards (AAVSB). • $55 dues fee required every two years. Current expiration: 12/31/2023

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Conference Rescheduled The FVMA has been closely monitoring the progress of the COVID-19 vaccine rollout timeline and has rescheduled our 92nd Annual Conference. CHECK WWW.FVMA.ORG FOR MORE INFORMATION

92

THE

nd FVMA ANNUAL CONFERENCE

JULY 8-11, 2021

HILTON ORLANDO BONNET CREEK & WALDORF ASTORIA ORLANDO ORLANDO, FLORIDA

Located at official Walt Disney World Resort® hotels!

WORLD-CLASS CONTINUING EDUCATION FOR EVERY MEMBER OF THE VETERINARY TEAM! (P): 800.992.3862 | (F): 407.240.3710 WWW.FVMA.ORG |

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Best Friends Forever

International Health Certificate Solutions orms, f Worldwide • Nationwide e h t o d We the exam airanimal.com ou do

Y

Photo credit: www.123rf.com/profile_sam74100

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covid-19

LEGISLATIONUpdate Congress has passed a fourth COVID-19 relief bill and a comprehensive spending package. Among the bill’s $600 stimulus check and increase in federal unemployment insurance are more specific provisions, including direct benefits for veterinary professionals in alignment with the American Veterinary Medical Association's (AVMA's) advocacy initiatives.

The AVMA initiatives, which directly impact veterinary professionals, that were addressed in the fiscal year (FY) 2021 funding bill passed by Congress are: • Language instructing federal agencies to coordinate One Health efforts, as dictated by the AVMA

The general provisions instituted by the legislation • $500,000 increase ($8.5 million) for the Veterinary includes: Medicine Loan Repayment Program (VMLRP); $3 million for the Veterinary Services Grant Program • Streamlined forgiveness applications for PPP loans (VSGP); and $2.5 million for the Food Animal up to $150,000 Residue Avoidance Databank (FARAD) • Clarification that ordinary business expenses • $3.2 million increase for the Animal and Plant paid with PPP loans that are forgiven are fully Health Inspection Service (APHIS) Center for deductible, which reverses an unfavorable IRS Veterinary Biologics ruling • $1 million increase for Horse Protection Act • $300 billion for the PPP enforcement and $350,000 increase Animal Welfare Act • Allowing second round of forgivable loans for small businesses that experienced a • A funding increase for USDA research, including 25% quarterly revenue decline between Agriculture and Food Research Initiative (AFRI) 2019 and 2020 and the Foreign Animal Disease (FAD) research program at the soon-to-be-completed National • Inclusion of 501(c)(6) organizations that Bio and Agro-Defense Facility (NBAF) have 300 employees or fewer, subjected to federal, state and local lobbying restrictions • Support for the continued establishment of the National Bio and Agro-Defense Facility (NBAF) • $20 million for animal health infrastructure to maintain and respond to animal disease prevention • $2.5 million for the Protecting Animals with and response capacity that was diminished with Shelter (PAWS) program the COVID-19 response

References:

All information was sourced from the AVMA at: https://www.avma.org/blog/covid-relief-and-spending-bill-address-veterinary-priorities

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FVMA LI K LIVE INTERACTIVE NETWORK FOR KNOWLEDGE

LIVE and ON-DEMAND Virtual CE! Our virtual continuing education portal meets all your CE needs and offers a wide-variety of topics to choose from! Join us!

Learn, educate, grow, inspire

— all in the comfort of your home or office.

The FVMA is your LINK to learning!

www.fvma.org/continuing-education/fvma-link/

Your LINK to online continuing education.

VETERINARY CE AT YOUR FINGERTIPS!

INFO@FVMA.ORG 800.992.3862 SIGN UP TODAY!

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FVMA 2021 ANNUAL OPERATING BUDGET APPROVED The FVMA Executive Board approved the Association's 2021 operating budget in November 2020, with a balanced budget of more than $3.2 million. This budget reflects the FVMA’s continued growth, as well as its commitment to the sustainability of the Association’s current programs and services, to advancing strategic goals and to broadening the delivery of high-quality services to the diverse veterinary professional community of our state. We are equally committed to exercising sound stewardship of FVMA membership fiscal resources. The strength of the FVMA has enabled us to expand our continuing education services and grassroots advocacy efforts, allowing the association to become the premiere voice of veterinary medicine in Florida. I encourage you to join the FVMA Professional Advocacy Committee or make a financial contribution. We ask members to become more engaged at the local level to support your association’s legislative and regulatory initiatives in 2021. We recognize the invaluable contributions all members of the veterinary team make to animal health and wellbeing, along with the advancement of our profession in Florida, and we invite these professionals to join our ranks to strengthen the voice of veterinary medicine in our state. The FVMA has the fiscal resources, experienced leadership, and the dedicated professional staff to expand and enhance our membership services and outreach. It's an all-encompassing effort to continue to serve our membership well, protecting and advancing the veterinary profession in Florida. The 2021 budget equips the FVMA to perform efficiently in all areas of operation and carry out all of its important functions. Let us be inspired by the FVMA’s mission statement: to advance the veterinary medical profession, promote animal health and well-being, and protect public health. If you have any questions regarding the 2021 fiscal operating budget, please direct them to me or Interim Executive Director Ann Wade. Thank you for the opportunity to serve this great profession. Respectfully,

Donald H. Morgan, DVM Treasurer

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FVMA 2021 FISCAL OPERATING BUDGET INCOME Membership Dues $ 1,045,522 FVMA Political Committee $ 25,000 Continuing Education/Certification Programs $ 1,910,000 Publications $ 112,989 FVMA Foundation $ 2,500 Member Services Income $ 105,100

TOTAL INCOME

$ 3,201,111

EXPENSES Facility Costs & Upkeep $ 216,500 Membership Services & Administration $  1,527,988 Legislative Advocacy $ 129,000 Educational Program Expenses $ 1,053,800 Communications & Public Relations $  114,958 Inter-professional Relations $  30,500

TOTAL EXPENSES

$ 3,072,746

NET INCOME OR (LOSS): $128,365

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PAIN MANAGEMENT IN THE DENTAL PATIENT Michael Peak, DVM, DAVDC Objectives

• Recognize the importance of dental pain management. • Convey important points of pain management and anesthetic safety to clients. • Alleviate any fears the client may have and remove barriers to proper dental treatment. • Become familiar with common nerve blocks, the materials needed to perform this procedure and how to implement them in your practice.

Pathophysiology

When it comes to sensation, the key sensory tissue for the tooth is the pulp and gingival soft tissue with surrounding alveolar bone. Noxious stimuli to the pulp only results in one sensation: pain. The pulp is innervated with alpha (acute pain) and C-delta (chronic pain) fibers that respond to any stimuli with pain. Try placing an ice cube on your tooth for a few minutes, you can’t tell it’s cold, but there will be a pain response. For this reason, many people avoid dental procedures and may also do the same for their pets. If we block that stimuli before it starts, then theoretically, pain management should be much easier.

Common Analgesics Used Perioperatively

Opioids: Morphine, hydromorphone, buprenorphine, fentanyl

When properly placed, the deep infraorbital nerve block deposits local anesthetic to the superior alveolar nerve branches as they branch off the maxillary/infraorbital nerve in the sphenopalatine fossa. Image courtesy of Dr. Michael Peak.

and others have been advocated for use as a premedication. These medications can be useful for pre, intra and post-operative analgesia. They act peripherally as well as centrally on the central nervous system to help agonize (stimulate) or antagonize (block) certain receptors to produce analgesic effects. Adverse side effects of respiratory depression, hypotension and GI upset may be avoided when used in conjunction with a sedative such as diazepam/midazolam, acepromazine or alpha-2 agonist. These are effective for use when mild to severe pain is anticipated.

Alpha-2 Agonists: Xylazine and medetomidine are occasionally used in conjunction with opioids or other sedatives to help reduce the amount of each needed to produce sedative effects while adding to the analgesic effect. These, like opioids, work both on receptors in the central as well as peripheral nervous system.

NSAIDs: These medications have an anti-inflammatory,

analgesic and antipyretic effect and are useful pre-operative as well as intra-operative and post-operative as long as there are no

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Max dose of bupivacaine (trade name Marcaine): 2-4mg/Kg Dog, 0.5-1.0mg/Kg Cat

Max dose of lidocaine: 2-6mg/Kg Dog, 2-6mg/Kg Cat 0.5% bupivacaine/Marcaine = 5mg/mL 2% lidocaine = 20mg/mL

Infraorbital Nerve Block

To estimate where the inferior alveolar nerve enters the mandibular canal, use a midpoint between the last molar tooth and the angular process of the mandible. The mandibular foramen is on the medial side of the mandible. Image courtesy of Dr. Michael Peak. contra-indications and perfusion remains normal throughout the procedure. These medications are useful as an injection, can be given orally and are not controlled substances.

NMDA Antagonists: Ketamine and amantadine are effective

medications to prevent the wind-up effect of pain prior to and during the incitement of pain. Ketamine is easy to add to IV fluids as a CRI and can be used in addition to opioids for effective CRI infusion.

Tramadol: Tramadol is a mu-agonist like some opioids and

inhibits the re-uptake of serotonin and norepinephrine. It is most useful as an adjunct to other analgesics for post-operative pain rather than used as a sole analgesic agent. Toxicity has been reported in a cat with serotonin syndrome. Recent evidence suggests Tramadol may not be as effective as an analgesic in dogs as once thought.

The infraorbital nerve block is performed by injecting 0.1-1.0mL (depending on the size of the patient) of the local anesthetic of the clinician’s preference at or around the nerve bundle as it exits the infraorbital canal just dorsal to the distal root of the third maxillary premolar by digitally palpating the infraorbital canal and injecting with a 1cc syringe and 25-27 gauge needle. In dogs, the canal is easy to palpate, but if there is difficulty finding it, the neurovascular bundle can usually be palpated by rolling your finger across the buccal mucosa dorsal to the second/third maxillary premolars. The neurovascular bundle will palpate similar to a tendon beneath the mucosa. By following this caudally to where the bundle goes into the canal, you can find the infraorbital canal. The author’s preference is to inject ventral to the neuromuscular bundle with the bevel of the needle facing the bone until the needle tip reaches the bone, then advancing the tip of the needle to the opening of the foramen. The plunger is always drawn back to ensure the needle tip is not in the infraorbital artery prior to injection. This nerve block should provide regional anesthesia of the buccal mucosa and buccal alveolar bone from the second premolar rostrally to the midline. This should be sufficient for gingival flap surgery in this area, but the deeper infraorbital nerve block is recommended for extraction of these teeth, so the superior alveolar nerves are also included in the desensitization.

Gabapentin: Gabapentin was initially developed as an anti-

seizure medication that may have some analgesic properties, particularly for chronic or neurogenic pain. Gabapentin is likely most effective when combined with other analgesics such as NSAIDs in a multimodal approach.

Maropitant: At least one study found that the neurokinin-1

antagonist, maropitant, improved visceral analgesia in dogs. This medication may also be used pre-operatively to help reduce vomiting in dogs due to other medications.

Local and Regional Nerve Blocks What you need:

1cc syringe with 25 or 27G x 0.5” needle for cats/small dogs 3cc syringe with 25G x 1.5” needle for larger dogs

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Using the intraoral approach to the mandibular foramen, to desensitize the inferior alveolar nerve, a finger can be placed on the mandibular foramen and used to guide the tip of the needle to the foramen. Image courtesy of Dr. Michael Peak.

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recommended for soft tissue surgery from the second mandibular premolar rostrally to the midline (gingivectomy, gingival flaps for periodontal surgery, etc.)

Inferior Alveolar (Mandibular) Nerve Block

Using the extra-oral approach to the mandibular foramen, an estimate is used to determine where the mandibular foramen is located (see image #2/caption). The needle tip is advanced through the skin at the ventral mandible until it encounters the ventral cortical bone. The tip is then “walked” off the bone medially until it can be advanced to the mandibular foramen. Care should be taken to keep the needle tip as close to the medial side of the mandible as possible, and judicious amounts (smaller amounts rather than larger) of local anesthetic should only be used to avoid the possibility of desensitization of the tongue. Desensitization of the tongue may result in tongue trauma by the patient once awake. Image courtesy of Dr. Michael Peak.

Maxillary/Deep Infraorbital Nerve Block

To desensitize the maxillary premolar, canine and incisor teeth on the ipsilateral side, the deep infraorbital nerve block can be employed. By advancing the needle into the infraorbital canal to the level of the medial canthus of the eye, drawing back on the syringe plunger to be sure the needle tip is not in the infraorbital artery, then injecting the local anesthetic, the superior alveolar branches of the maxillary/infraorbital nerve are blocked, which supply the fourth premolar and the teeth rostral to this level. These nerves enter the incisivomaxillary canal at the caudal extent of the infraorbital foramen just after the infraorbital nerve enters the infraorbital canal. To desensitize further caudally, the needle can be advanced slightly further in the infraorbital canal, or the needle can be inserted into the palate mucosa just caudal to the last molar and advanced 0.5-1.0cm to the level of the maxillary branch of the trigeminal nerve before it enters the infraorbital canal in the sphenopalatine fossa.

Middle Mental Nerve Block

The middle mental nerve arises from the middle mental foramina just caudal to the mandibular frenulum, ventral to the mesial root of the second premolar or just caudal to the level of the apex of the mandibular canine tooth. The foramen can usually be palpated with a fingernail by using firm pressure in this area. The foramen will feel like a depression in the bone. This foramen is not readily palpable in the cat. In a study by Krug, et. al., the middle mental nerve block was not found to consistently desensitize the mandibular canine tooth/incisors so this nerve block is only

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The inferior alveolar nerve block is performed by injecting a small amount of local anesthetic at the midpoint of an imaginary line drawn from the angle of the mandible and the distal aspect of the mandibular third molar tooth (the last molar). Sometimes, the foramina can be palpated intraorally to give the practitioner a better idea of where this nerve should be blocked. If the foramen can be palpated from within the mouth, the needle can be inserted and advanced to this level, otherwise, the extraoral approach can be utilized. With the extraoral approach to the inferior alveolar nerve, the index finger is placed on the distal aspect of the last molar, and the thumb is placed on the angle of the mandible and again, an imaginary line is formed between these two points. Inserting the needle through the skin on ventral surface of the mandible the tip is advanced until it hits the ventral cortical bone. The tip of the needle is then “walked” off the bone medially until it advances on the medial aspect of the mandible to the midway point of the imaginary line drawn between the thumb and index finger. Particular attention is paid to keep the tip of the needle close to the mandible, and the local anesthesia is delivered at the level of the mandibular alveolar foramen as the mandibular nerve enters this foramen. Caution should be used when performing this block in cats and dogs that are not undergoing mandibulectomy or complete mandibular quadrant extractions due to the proximity of the lingual nerve to the injection site, which could result in the loss of sensation in the rostral two-thirds of the tongue and, subsequently, the possibility of self-mutilation.

Michael Peak, DVM, DAVDC Dr. Michael Peak graduated with honors from Auburn University’s College of Veterinary Medicine. He completed a veterinary dentistry residency at the Dallas Dental Service Animal Clinic in 2000 and became board certified in veterinary dentistry by the American Veterinary Dental College in 2001. He has served as president of the American Veterinary Dental College, chair of its Examination Committee, chair of its Fiscal and Audit Committee, and chair of the Board of Directors. He has also been the program chair for the Veterinary Dental Forum— the world’s largest veterinary dentistry continuing education meeting—and chair of the Veterinary Dental Oversight Group, a committee who oversees the operations of the Veterinary Dental Forum. He is co-owner of The Pet Dentist at Tampa Bay, LLC.


Health Insurance Inspired by You AVMA members, their employees, and their family members now have access to affordable health care through the AVMA Trust Association Health Plan (AHP). • 100% coverage of rabies vaccine and titer testing in PPO plans • No health information required to enroll • No restrictions on pre-existing conditions • Premium rates are guaranteed through December 31, 2021 For eligibility and enrollment, visit:

AVMATrustAHP.com

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Practice Pulse QUESTION: Is the FVMA advocating for veterinary hospital

employees to receive the COVID-19 vaccine, as when we were deemed essential workers?

A: The governor announced and shared an executive order that

differs from CDC guidelines for vaccine rollout. This order has deemed a priority one group to be given the initial vaccines Florida receives. The priority one group includes those in nursing homes and the personnel providing care in those homes; elderly citizens 65 and older; health care providers working with human patients; and persons deemed to be extremely vulnerable to COVID-19 by hospital providers. The governor's decision does not go beyond this priority grouping for the initial vaccines. We expect that as more vaccines continue to arrive in Florida, we will be provided updated guidance from the governor or department of health. Rest assured, the FVMA continues to advocate on your behalf and seeks a clearer understanding of how the vaccines will be administered as more become available to us. We’re advising members to sign up for text updates from their local authorities. The information provided will include how/when to register for vaccination. To sign up, text FLCOVID19 to 888777.

QUESTION: Is a relief vet forced to use their DEA license at a facility if the vet does not have a certain narcotic? Isn't it true you can have your own DEA license as a relief vet for your personal use for your pets and not use it for your business? A: A DEA registration is personal to the veterinarian. Nobody can

“force” a veterinarian to do something with their registration they do not want to do. The facility has the right to get another veterinarian that may be willing to use his/her DEA registration to purchase drugs for use at the facility. Prescribing controlled substances for your own animal is not a good idea and may well be illegal. Some states specifically prohibit it. In order to legally prescribe any medication, there must be a legitimate veterinary-client-patient relationship (VCPR). When the veterinarian prescribes for his/her own animals, there is no client.

QUESTION: What if I say I am the client and the vet for my pets and am doing a VPR with my pets? Then, can I RX narcotics to them, if ever needed? A: In Florida, a physician is prohibited from prescribing any controlled

substance to himself. Although there is no similar explicit prohibition in the Veterinary Medicine Practice Act, a veterinarian may be disciplined for: Using the privilege of ordering, prescribing, or making available medicinal drugs or drugs as defined in chapter 465, or controlled substances as defined in chapter 893, for use other than for the specific treatment of animal patients for which there is a documented veterinarian/client/ patient relationship. Pursuant thereto, the veterinarian shall:

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1. Have sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian is personally acquainted with the keeping and caring of the animal and has recently seen the animal or has made medically appropriate and timely visits to the premises where the animal is kept. 2. Be available or provide for follow-up care and treatment in case of adverse reactions or failure of the regimen of therapy. 3. Maintain records which document patient visits, diagnosis, treatment, and other relevant information required under this chapter. A veterinarian can treat his/her own animals. The moment the vet prescribes any medication (not just a controlled substance) outside of a legitimate VCPR he/she may be subject to discipline. A VCPR requires three distinct parties: the vet, the client, and the patient. The vet can have the best records in the world, but if those records do not show a client, there is a problem from the perspective of prescribing, not treating.

QUESTION: I am a practice owner, veterinarian and FVMA member. A client of mine has a six-year-old dog that is extremely aggressive. This dog has been aggressive at the vet office since puppyhood. The owners are an elderly couple who are having health issues, including dementia. They now have a Power of Attorney (POA) who is involved in their daily activities. The dog came in yesterday for limping and at the end of the appointment the Power of Attorney casually mentioned to my technician that the dog has bitten multiple household members over the past two months. I called the POA after closing last night to get more information. All bites have been to the hands and have drawn blood. The bites occur when the owner tries to move the dog or is giving him food by hand. Medical attention has not been sought for any of these bites. The dog bit the male owner (his hand was bandaged for a month per POA), the female owner and their at-home nurse. I told the POA that this behavior is unacceptable, and this is a serious situation as the bitten individuals could become very ill from a dog bite (especially elderly persons.) I prescribed behavior medications and told the POA that we can see if they help. I told the POA that in the meantime no human is to hold, pet, reach for, touch, etc. this dog until we can see if behavior medications are helpful... but if the aggression continues to escalate, then the dog needs to be removed from the home and humanely euthanized. I told the POA to contact me immediately if the dog bites anyone else. This morning, the POA came to pick up the behavior medications and brought them to the owners. When the female owner gave the dog the medication the dog bit her hand. The female owner refuses to listen to my advice and continues to hold the dog in her lap. I spoke with her directly this afternoon and she told me "there is no way I will ever give up my dog." I have documented all of this information in the patient's medical record, but I want to be sure that I take the appropriate steps to be in compliance with the Florida Veterinary Statutes and local authorities as well. What are my obligations in this situation?


GOT A QUESTION? THE FVMA CAN HELP.

One of the benefits of an FVMA membership is our helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-6 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes. A: The person holding the power of attorney should be notified and advised of the vet’s concerns. It is up to that person then to make the decision. It seems that as long as the dog has not bitten anybody except the owners, there is no reporting requirement to the animal control authorities.

QUESTION: I’m a veterinarian who recently moved out of clinical practice and need to dispose of a few controlled drugs. I have contacted the DEA and reverse distributors, but the expense of using a reserve distributor is as much as renewing my DEA license. Is there a way to transfer controlled drugs to a currently practicing veterinarian with a DEA license? A: You cannot transfer controlled drugs to another veterinarian,

unless it is in the case of a sale of your practice, when there is a transfer exemption that allows a one-time transfer from an owner to the new owner. In this case, a detailed inventory and invoice showing the drugs transferred and signed by the selling vet and the buying vet are requirements. The applicable Federal Rule on destruction is copied below. Please note (c) destruction must render the drugs non-retrievable §1317.90 Methods of destruction. (a) All controlled substances to be destroyed by a registrant, or caused to be destroyed by a registrant pursuant to §1317.95(c), shall be destroyed in compliance with applicable Federal, State, tribal, and local laws and regulations and shall be rendered non-retrievable. (b) Where multiple controlled substances are comingled, the method of destruction shall be sufficient to render all such controlled substances non-retrievable. When the actual substances collected for destruction are unknown but may reasonably include controlled substances, the method of destruction shall be sufficient to render non-retrievable any controlled substance likely to be present. (c) The method of destruction shall be consistent with the purpose of rendering all controlled substances to a non-retrievable state in order to prevent diversion of any such substance to illicit purposes and to protect the public health and safety. Please note (d) on-site destruction below. Two employees must witness the substances destruction (the vet qualifies as an "employee" for this purpose). §1317.95 Destruction procedures. The destruction of any controlled substance shall be in accordance with the following requirements: (a) Transfer to a person registered or authorized to accept controlled substances for the purpose of destruction. If the controlled substances are transferred to a person registered or authorized to accept the controlled substances for the purpose of destruction, two employees of the transferring registrant shall load and unload or observe the loading and unloading of any controlled substances until transfer is complete.

(b) Transport to a registered location. If the controlled substances are transported by a registrant to a registered location for subsequent destruction, the following procedures shall be followed: (1) Transportation shall be directly to the registered location (the substances shall be constantly moving towards their final location and unnecessary or unrelated stops and stops of an extended duration shall not occur); (2) Two employees of the transporting registrant shall accompany the controlled substances to the registered location; (3) Two employees of the transporting registrant shall load and unload or observe the loading and unloading of the controlled substances until transfer is complete; (c) Transport to a non-registered location. If the controlled substances are transported by a registrant to a destruction location that is not a registered location, the following procedures shall be followed: (1) Transportation shall be directly to the destruction location (the substances shall be constantly moving towards their final destruction location and unnecessary or unrelated stops and stops of an extended duration shall not occur); (2) Two employees of the transporting registrant shall accompany the controlled substances to the destruction location; (3) Two employees of the transporting registrant shall load and unload or observe the loading and unloading of the controlled substances; (4) Two employees of the transporting registrant shall handle or observe the handling of any controlled substance until the substance is rendered non-retrievable; and (5) Two employees of the transporting registrant shall personally witness the destruction of the controlled substance until it is rendered nonretrievable. (d) On-site destruction. If the controlled substances are destroyed at a registrant's registered location utilizing an on-site method of destruction, the following procedures shall be followed: (1) Two employees of the registrant shall handle or observe the handling of any controlled substance until the substance is rendered nonretrievable; and (2) Two employees of the registrant shall personally witness the destruction of the controlled substance until it is rendered nonretrievable. The following link takes you to the form that must be used when performing on-site destruction: https://www.deadiversion.usdoj.gov/21cfr_reports/surrend/41_ form.pdf Finally, the link below is for a product (Rx Destroyer) that can be used. https://www.rxdestroyer.com/

END NOTE: The ultimate responsibility

in the practice of veterinary medicine lies with the licensed veterinarian. Professional discretion must always be exercised. WWW.FVMA.ORG |

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CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED

VETERINARIAN WANTED – TAMPA, FL: Vetaroo is seeking an entrepreneur minded Veterinarian to grow our client base in our BRAND NEW state of the art hospital! Located in Tampa, with a planned opening in December of this year, our innovative facility is designed specifically for patient comfort and safety with high end aesthetically pleasing finishes, and integrative technology designed to support seamless communication with our clients. Our goal is to exceed ALL client expectations. The ideal candidate would possess the following: 1. Growth mindset- financially, medically, and integrative technology. 2. Collaborative- able to work in the gray area with an outside team, striving towards a proof of concept (Vetaroo). 3. Communicative- shared learnings, open, honest, and timely communication. 4. Compassion- for pets and people alike. 5. Proactive- ownership mentality, driven to improve. 6. Authenticity- honest in motivating factors, personal goals, professional goals, leadership capabilities. 7. Leadership- team building, client communication, and education. Are you interested in revolutionizing the veterinary field with us? Email us at Hello@Vetaroo.com to learn more. (6/20; ID#49286) VETERINARIAN WANTED – SOUTHWEST FLORIDA: Progressive AAHA small animal after hours ER in beautiful SW Fl looking for a talented and compassionate vet. Established in 1993 we have great community support and pride ourselves on being a service oriented, friendly, supportive practice for pet owners and employees. As a privately owned practice all policies and decisions are made in house. Your opinions, goals and priorities matter here. Associate vets have typically stayed 4-10 years and remain friends today. New grads have stayed 4, 9, 5 and 10 years. Confident new grads are welcome - we are happy to mentor. Salary plus commission bonuses should run 165 - 200+K. Our normal schedule rotates every 3 weeks (working 2, taking 3rd off), totaling 12-13 shifts monthly leaving plenty of time for other interests. Other benefits include matching IRA, liability, 1/2 health insurance, professional dues, CE. Please contact us to learn more. admin@naplesemergencypet.com or 239-250-6866. (6/20; ID#7643) VETERINARIAN WANTED – TAMPA, FL: We are seeking a full time shelter veterinarian to preform high volume sterilizations, diagnostics and treatments for the over 10,000 shelter animals we care for each year. The Humane Society of Tampa Bay is a cutting edge animal shelter which maintains a save rate of over 90%. We have built a new state of the art shelter which opens September 2020. Generous benefit package which includes medical/dental/vision, life insurance, disability and paid time off. If you want to make a difference in animal welfare, please apply https://humanesocietytampa.org/careers MUST HAVE A Florida Veterinarian License. (6/20; ID#49259) VETERINARIAN WANTED: PONTE VEDRA FLORIDA: We are AAHA accredited small animal hospital growing fast. Come join our family. We are close to beautiful beaches and great outdoor activities. We offer work life balance and a competitive salary. We are looking for an associate who loves soft tissue surgery, dentistry, internal medicine and fear free handling. Partnership opportunity for those interested. Nease Animal Hospital, 10440 US Highway 1 N Suite 101 Ponte Vedra FL 32081; neaseah@gmail.com (6/20; ID#28811) PART-TIME VETERINARIAN WANTED – VENICE, FL: Part-time veterinarian wanted for cat clinic in Venice, Florida. If you are seeking work/ life balance in a non-chaotic environment, we would enjoy meeting you. We also see a small number of pocket pets and provide care for a local cat-only shelter. We are a general practice and utilize specialists and local 24-hour emergency clinics. For more information please contact Dr. Robin Hughes at (941) 882-4580. (6/20; ID#1547) VETERINARIAN WANTED – SUN CITY, FL: FOX AND FRIENDS ANIMAL HOSPITAL IN SUN CITY, FL IS LOOKING FOR AN ASSOCIATE VETERINARIAN! Fox and Friends Animal Hospital is a fast-paced, full-service Veterinary Clinic located in Sun City Center, Florida. We are currently seeking an Associate Veterinarian to join our busy and growing practice! Fox and Friends is a boutique small animal practice serving our community for over 20 years. We enjoy a great internal collaborative

28  |  FVMA ADVOCATE

culture and have a loyal client base the trusts us with your loving pets. We look forward to hearing from you! We welcome all applicants and would be happy to mentor young doctors beginning their careers. We look forward to hearing from you. BENEFITS: Competitive Salary, Mentorship, Growth Opportunities Available, Health Benefits, 401K with Match, CE and more... LOCATION LOCATION LOCATION: Located near some of the most beautiful beaches in Florida! All the outdoor recreation you could want in a destination location!! CHECK US OUT HERE Apply Here: https://www.Click2Apply.net/vw45k3qzjd6sv2bv PI122786691 (6/20; ID#49222) VETERINARIAN WANTED – FORT LAUDERDALE, FL: Associate Veterinarian in SUNNY FLORIDA – minutes from the beach Healing Paws Center - Fort Lauderdale, Florida 33334 We specialize in the fast-growing field of Holistic and Integrative Veterinary Care, including acupuncture, rehabilitation/physical therapy & rehabilitation, laser therapy, nutritional consultations, herbal therapy, hydrotherapy, and much more! For more information please contact Dr. Jessica Dreyfuss at (954) 224-2424. (6/20; ID#30307) VETERINARIAN WANTED – TALLAHASSEE, FL: Veterinary Medical Director Have a passion to make a difference? Want to be part of a team that is committed to providing high quality patient care in a workplace where you can have fun and work hard? The Animal Shelter Foundation, a non-profit organization whose mission is to help the homeless animals in the community and to reduce pet overpopulation, is seeking a Veterinary Medical Director for a brand new Spay/Neuter Clinic in Tallahassee, FL. This 4,100 square foot 1-vet high-quality, high volume, low cost, clinic is based on the gold standard ASPCA® Spay/Neuter Alliance model. Seeking experienced surgeon, confident, caring veterinarian to lead our medical team. Being a new clinic, you will have the opportunity to provide input and shape the inner workings of the clinic. Companion pets, rescue pets and community cats will be seen 4 days a week, doing 30-40 surgeries per day, with additional one day events throughout the year. The spay/neuter Veterinary Medical Director performs all surgeries, establishes policy and directs the medical team in the surgical wing of the clinic. Day-to-day operations of the clinic fall to other staff members. Candidates must have a current DVM license and be eligible to practice veterinary medicine in Florida and obtain a DEA license. We offer competitive pay, benefits and professional development. Benefits: • Competitive salary • Paid Time Off • Health Insurance • Professional Development • No State Income Tax We are extra excited if you are that person that: • Is passionate in helping people and their pets and the homeless animals. • Is excited to learn new things, teach others and enjoys being part of a team. • Sometimes wakes up in the morning and thinks you are a superhero! Email your resume to lauren@animalshelterfoundation.org to start the process of Awesomeness! (6/20; ID#49193) VETERINARIAN WANTED - KISSIMMEE/ORLANDO AREA: Want a great work-life balance? We are looking for a S/N vet who likes the fast-paced surgical life to compliment the 3 days of downtime. Close to major theme-park attractions, the beach with a convenient train or highway commute. Make a positive impact in your community! For more information please contact Shelia Westerveld via email at sheila.westerveld@letssnipit.org. (6/20; ID#17171) VETERINARIAN WANTED – BELLEAIR BLUFFS, FL: Bluffs Animal Hospital is an AHAA accredited small animal general practice that is located in Belleair Bluffs on the west coast of Florida within Pinellas County. We are located minutes from beautiful beaches in Clearwater and Indian Rocks and in close proximity to Tampa, St. Pete, and Dunedin. We are a privately owned clinic and have been since 1961 with no interest in transitioning to corporate. Bluffs is a walk-in clinic that only requires appointments for surgery, boarding, and grooming. This allows us to spend adequate time with patients and provide the best care possible while offering opportunities for both traditional general practice and emergency medicine.


We place a high emphasis on quality of life and work life balance. We are open from 8-5:30 during the week with a one-hour lunch break. On Saturday we are open from 8-12:00. Our doctors have one full day off during the week as well. We do not require any after hours on call. We strive to practice high quality medical care with current best practices dictated by evidence-based medicine. We have APR Vet digital radiograph unit, Acuson X300 ultrasound, MidMark VetPro DC dental radiograph unit, SurgiVet surgical monitors, and Companion Animal therapeutic laser. We are currently looking for a full-time veterinarian to come join the Bluffs team. We are happy to offer mentorship and encourage new graduates to apply. We offer a competitive salary and benefits. For more information please contact Beth Crawford at info@bluffsanimal.com. (6/20; ID#2291) VETERINARIAN WANTED – NAVARRE BEACH, FL: Come join our team! SA DVM needed Are you ready to love where you work and relax on the beautiful beaches in the Florida panhandle? Then Navarre Animal Hospital is for you. Navarre beach is conveniently located between Pensacola and Destin. We are seeking a PT/FT, dedicated, enthusiastic small animal veterinarian to join our team. Our practice is well established with professional, friendly staff and great clients. We are completely equipped with in house Idexx diagnostics, digital radiography, and Avimark software. We offer an excellent salary and benefits package. Please send resume to Dr. Kevin Sibille at Navarre Animal Hospital, 8172 Navarre Parkway, Navarre, FL 32566 Phone (850) 939-1373 or e-mail to: navarreanimal@bellsouth.net. (6/20; ID#25843) PART- OR FULL-TIME VETERINARIAN - FLORIDA: It’s time to love your work again. IndeVets puts you in control of your career and eliminates all the nonsense that can suck the joy out of your job. You choose your own hours and hospital locations, earn top notch pay, health insurance, and a slew of benefits. Find your happy places to work and schedule the hours that best fit your life. Most importantly, get paid for your time – not your production. Rediscover the joy of veterinary medicine. Choose shifts from any of our 500 partner hospitals — small private practices, large corporate practices, shelters, and ER hospitals — and customize your schedule to suit your unique needs. All our hospital partners are thoroughly vetted (think: dad-meeting-your-prom-date-level-vetting) and our hospital profiles help fill in the blanks on workflows & procedures (say goodbye to first-day jitters!) Join a community of like-minded doctors who support you in your growth and development. Our management team is comprised of vets and associates who know this world, and want to make it better. Colleagues that get you aren’t the only benefit to joining IndeVets. You’ll also earn benefits. Specifically: • Medical Insurance • Dental Insurance •Short-Term Disability Insurance • Long-Term Disability Insurance • Paid-Time Off • Continuing Education allowance (includes additional PTO) • Reimbursement for state license and AVMA membership Company-Paid Liability / Malpractice Insurance • 401(k) contributions •Equity ownership plan available after 1 full year of service (profit sharing!) Sound good so far? The ideal IndeVet will have a minimum of two years of post-DVM/VMD work experience and have an active veterinary license. Apply at www.indevets.com or email andrew@indevets.com (6/20; ID#49368) VETERINARIAN WANTED – NAPLES, FL: Quality of life, quality of practice, what more could an associate want? Well, how about mentorship and teamwork? Gulfshore Animal Hospital has all of these to offer to the veterinary associate fortunate enough to join our practice. We have been a top ranking AAHA practice since 1996. Our clientele demands excellent veterinary care and, personalized professional service, and our team delivers. Learn all the skills you will ever need from the combined 70 years of experience of our 2 doctors. Enjoy the satisfaction and fulfillment that true team comradery can bestow in practice. Naples is ranked among the topmost desirable beach destinations in the US; a great place to visit, but an even better place to work and live. If this sounds like an inviting offer, it is! We can promise you that the visit alone to-our beautiful town will be well worth it. Experienced or new graduates are both welcome to apply. Salary includes base and production compensation which can easily exceed $100K in the first year. The fulltime position also includes an excellent benefits package and relocation expenses allowance. Future ownership opportunities available if desired. Please email your resume, along with your introductory letter explaining your goals and aspirations for your veterinary career to drdave@gulfshoreanimalhospital.com. (6/20; 1/21 ID#26066)

VETERINARIAN WANTED – NAPLES, FL: FULL TIME VETERINARIAN in beautiful Naples, Florida. Town and Country Animal Hospital is dedicated to our small animal patients and is looking to expand our AAHA accredited 2 doctor practice. The practice employs a full complement of in-house state-of-the-art diagnostics, as well as digital and laser technologies. Our practice focuses on preventative care, houses a dedicated surgery suite and emphasizes canine and feline dentistry . Our board certified Theriogenologist Dr. Carver-Raffa offers a full array of reproductive services. We offer a fixed salary, an alternating 4 to 4 ½ day work week, an annual bonus participation plan, a generous package of paid personal benefits, CE opportunities and a progressive environment for long-term professional growth and mentorship. Please visit our website (www.mynaplesvet.com) for further information about out practice. Email your resume in confidence to: janiechet@hotmail.com. (6/20; ID#598)

CVT WANTED

CERTIFIED VETERINARY TECHNICIAN WANTED – ORLANDO, FL: Certified Veterinary Technician 2 or 4 year program with interest or proficiency in anesthesia and dentistry/dental xrays needed for AAHA and Cat Friendly Hospital. Orlando suburb near UCF. 18.00 plus per hour plus benefits. Must like cats. Email resume to woodyvet22@gmail.com www.oviedoveterinarian.com. (6/20; ID #10450)

RELIEF VETERINARIAN

RELIEF VETERINARIAN: "Got to get away? "VetRxRelief , 37 years experience small animal Veterinarian. Please call 321-508-3879 or Vetgator@gmail.com. (6/20; ID #2187)

PRACTICE FOR SALE/LEASE

PRACTICE FOR SALE - SW BROWARD COUNTY: Small animal clinic located in affluent SW Broward County; FL. Practice has been in current location for over 20 years. 1200 sf 2 exam rooms, 1 surgical room, grooming room, treatment room and kennel room. Pictures available. Please contract Stuart M. Auerbach, DDS Henry Schein Professional Practice Transitions. Stuart.Auerbach@henryschein.com Cell: 954.298.4575. (6/20; ID#18359) PRACTICE FOR SALE – BARTOW, FL: Turnkey ready Veterinary building and practice! Located in the heart of Bartow, Florida, this clinic has been a Veterinary practice for decades. Due to the passing of its longtime owner, the practice and clientele are ready for a new owner. A groomer is on the property paying monthly rent. The property includes all veterinary equipment, x-ray machine, surgical instruments, stocked pharmacy and more. There are boarding kennels with extensive grounds. Please see the link below to view the realtor's website for more information. https://homesbycarla.net/homes-for-sale-details/775-W-MAIN-STREETBARTOW-FL-33830/L4915639/32/ (6/20; ID#28141) PRACTICE FOR SALE – PIERSON, FL: Small animal clinic for sale in Pierson (Northwest Volusia County). Rented facility inside local familyowned feed store. Grossing approx. $350,000 with part-time hours. Needs to be operated full time. Very inexpensive to purchase and operate with high net income and a large under-served population with no other clinics for miles. Growth potential is unlimited. Owner wishes to retire asap. Contact dkanfer@cfl.rr.com or 386-451-9253 and leave message. (6/20; ID#28696) PRACTICE FOR SALE – MELBOURNE, FL: Turn Key, fully equipped hospital , Space Coast, close to beach, marina, and shopping. Equipment also for sale separately. Call 321-508-3879 or VetGator@gmail.com. (6/20; ID#2187) COMMERCIAL BUILDING FOR LEASE – EAST BOCA RATON, FL: 3,000 sq. ft of commercial building for lease. Adjacent to busy, small animal hospital. Located on Federal Highway in beautiful, affluent East Boca Raton, Florida. Ideal for a Veterinary Specialist wanting to start a practice. Will divide. Avail for immediate occupancy. For more information please contact Dr. Kelly Phillips at (561) 715-1753. (6/20; ID#16821) PRACTICE FOR SALE NE MIAMI-DADE COUNTY: Profitable small clinic, located in fast growing NE Miami-Dade county ,Florida, minutes from nice schools , sunny beaches. Next to busy road, near major highways, 1200 sf 2 exam rooms, 1 surgical room, lab area, treatment room. Practice has been in current location for decades, loyal clientele , long term staff, 4.5 days , 2019 gross 633K, cash flow 280K. Owner is offering 50K upgrade allotment at closing. For more information Please contact southfloridavet85@gmail.com or 305 684 3265. (6/20; ID#49454)

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Practices for Sale FL: NEW LISTING in Clearwater: 1 DVM, SA practice with real estate, grossing $890K, well equipped, and growing. PRX + RE (FL007A) FL: Central: SA Solo Dr Prx. 20 mi NW of Orlando. A Must See Practice-Exceptional. Pool. >$1.1M+ gross & growing. Well equipped. Prx & RE (FL12A) GA: South Central: Grossing >$1.1M+ & growing, 1.5 Dr practice. Attractive facility with 5 acres and modern equipment. (GA14F) GA: AAHA Listing - Savannah-Coastal: 1 DVM SA Prx w/RE incl 2 acres, Approx 4084SF spacious facility. Significant opportunities for growth. Well Equipped. Gross $657K. (GA20S) SOLD! SC: Greenville & Spartanburg Area: 2+ Dr. SA Prx w/RE on 4+ ac. Plus extra lot on major hwy. >$2M gross & growing. (SC13W) UNDER CONTRACT! SC: Upstate West South Carolina: 2019 Gross of $2.5M with projected 2020 Revenues approx. $3M! 2 Doctor SA Prx w/RE Incl 1.6 Acres, Approx 5764SF Spacious Facility. Well Equipped. (SC30W) NC: AAHA Listing - Piedmont Triad/Growing Area: 1.25 DVMs SA, Approx 3000SF spacious facility. Only open 4.5 days a week. Well Equipped. PRX & RE $625K. (NC15B) NC: Northeast, near VA: Immaculate, well-equipped facility- digital x-ray, in-house lab, companion laser. $1.1M+ gross, 2 dr., SA w/ LA capability. (NC66G) GA: NEW LISTING in South Atlanta Area: Solo SA Prx w/ RE, Approx. 2,217SF spacious facility. Open 4.5 days a week + 1/2 day Saturday. Well Equipped. Gross $630K+. Prx & RE. (GA48C) 1610 Frederica Road, Saint Simons Island, GA 31522 Toll Free: (800) 333-1984 | www.simmonsinc.com Email: southeast@simmonsinc.com Licensed in Florida, Georgia, North Carolina, and South Carolina Real Estate Broker

Veterinary Practice Sales, & Valuations Practices for Acquisitions Sale

LEON COUNTY: Long-established practice. $744K gross and $129K after-debt income in 2019. 1,978 SF facility w/ RE. Seller financing available. FL97 BROWARD COUNTY: Profitable practice! Over $1.2M gross and $206K after-debt income in 2019. 3,000 SF leased facility. Heavy traffic area. FL100 HARDEE COUNTY: Double-digit growth! Expecting to gross over $1M this year. $203K after-debt income in 2019. 2,400 SF facility w/ RE. Seller financing. FL101 BROWARD COUNTY: Start-up practice in prime location! New, top-notch equipment. Turnkey and ready for a doctor! 2,000 SF facility w/ RE. FL102 & FL103 BREVARD COUNTY: Double-digit growth! $1.1M gross in 2019. After-debt income over $262K. Beautiful 1,900 SF facility w/ RE. Excellent location. FL104

psbroker.com | 800.636.4740 | info@psbroker.com

Florida Practice Listings! North Central Fl.– 1.5 Dr. 2020 gross ~$800K, free standing clinic w/ 2 exam rooms, in-house lab, digital x-ray, great staff. Primary Vet in this practice is willing to stay on. Price Reduction-Eastern Panhandle– 1 Dr. w/ 2019 gross of $712K, 3200 sq. ft. clinic, 2 exam rooms, in-house lab, digital xray. Great small town atmosphere, only an hour from the Gulf Beaches. Palm Beach Co.- Solo Dr. 2020 gross ~$550K, 1800 sq. ft. lease space. Quality clientele, well equipped, experienced staff. S.E. Fl.– Well established solo Dr., lease space, 2019 gross ~$480K, with 4 1/2 day work week, 2 exam rooms, well equipped, growing area west oof turnpike, owner ready to retire Equine Practice– Brevard Co.-Rare opportunity to buy a turnkey Equine practice on the central east coast. 1 to 1.5 Dr. 2019 gross $670K. Barn, stalls, treatment area, paddocks, office Sold-SE Coastal Fl.– Owner Financing for a qualified buyer, Solo Dr., 2019 gross $688k, 6100sqft office and boarding space Sales….Valuations….Buyer Representation….Exit Strategies Are Corporate Groups contacting you about buying your Practice? If so, let us help make sure you get your best deal!!!

Contact Dr. Richard Alker for further practice information.

850.814.9962 or Richard@tpsgsales.com Showcase Properties of Central Florida, Broker

30  |  FVMA ADVOCATE


Are you One of thousands...

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PRACTICE SALES VALUATIONS ASSOCIATE BUY-INS CORPORATE SALES BUYER REPRESENTATION

with

NEIGHBORHOOD service

FLORIDA LISTINGS CENTRAL FLORIDA

$50,000 UPGRADE INCENTIVE AT CLOSING GROSSING OVER $700K! ATTACHED LIVING QUARTERS

REBECCA ROBINSON DAVIS, CBI BRENNAN MCGOLDRICK, DVM, MBA

UNDER CONTRACT! MIAMI GROSSING OVER $1MILLION! NEAR BUSY PARKWAY LEASED FACILITY

*See National Listings @ practicesalesadvisors.com

912.268.2701 | HELLO@PRACTICESALESADVISORS.COM WWW.PRACTICESALESADVISORS.COM


Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809

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YOU’LL NEVER BE THE LEAD DOG WORKING FOR SOMEONE ELSE. Being an owner will help you retire debt faster while creating the practice of your dreams. You can establish the quality of care and service, choose your schedule, and achieve significant financial success.

Is it time for you to break from the pack? Since 1977, the experts at Simmons have helped veterinarians buy their own practice – even those burdened with student debt. Trust Simmons to guide you through the buying process.

Call us today at 800.333.1984 for a complimentary and confidential conversation.

simmonsinc.com It’s your future - Own it.

Profile for FVMA

Advocate Issue 6, 2020  

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