Advocate Issue 4, 2016

F V M A ADVOCATE Published by The Florida Veterinary Medical Association

ISSUE 4 │ 2016 │ www.fvma.org

89th President of the

FLORIDA VETERINARY MEDICAL ASSOCIATION

Richard C. Sutliff, DVM

President's MESSAGE Time is a strange bedfellow. In the few months since becoming the president of the FVMA there certainly has not been enough of it to satisfy my needs. Near the end of June I was invited to sit on a panel discussion titled “Issues Facing Veterinary Medicine Today” hosted by the Pasco Hernando VMA. On the panel were three local VMA presidents, the AVMA Vice President and myself. Prior to starting the open question forum we were each requested to state what we thought was the primary problem in our industry today. Excellent comments about industry secularization, failures to fully leverage our staff members, and possible communication issues were offered. I wrote and recited the following prepared statement which I now share:

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OFFICERS

Dr. Richard C. Sutliff President Dr. Alex M. Steverson President-Elect Dr. Donald H. Morgan Treasurer Dr. Richard M. Carpenter Past President Mr. Philip J. Hinkle Executive Director

DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Julia Conway District 2–Northeast Dr. Marc A. Presnell District 3–Central Dr. Rachel Klemawesch District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Marta P. Lista District 6–South Florida Dr. Mary Smart District 7–Southwest Dr. James M. Brechin District 8–Northwest Dr. Kelly J. Sloan-Wade District 9–Space Coast Dr. Ernest C. Godfrey AVMA Delegate Dr. Richard B. Williams AVMA Alternate Delegate Dr. Amanda House FAEP Representative to the FVMA Executive Board Ex Officio Dr. James W. Lloyd, Dean UF College of Veterinary Medicine

“The main issue in our industry is the devaluation of our profession both externally by the public and internally by our own members. We spent many years and a great deal of investment to bring veterinary medicine to the pinnacle of quality medical animal patient care. We built state of the art Veterinary College Hospitals to teach those that are the future of our hollowed industry cutting edge knowledge.

Then we allow our industry to be seen as overpriced in comparison to heavily subsidized nonprofits that refuse to income qualify for their charitable distributions. We allow street corner vaccine clinics to devalue the need for full wellness exams and promote that “vaccination equals good health”. Our rural practices have trained farm hands to do most of the needed activities not as our partners, but as our replacements.

This devaluation of my studies, my degree, and my profession directly has led to our industry not being able to offer the salaries to the new graduates that they deserve and need for wellness in their lives.

We insist, rightfully so, that a veterinary education is robust and cutting edge. We subsequently allow our profession to promote the idea that we should live discounted lives.”

The statement is a little dark, but challenging issues within any industry tend to fall in that direction.

The panel discussion then proceeded with responses to questions submitted online prior to the event and were enlightening and lively.

In the short time since that meeting (there is that time thing again), I have had the privilege of attending the PSI Symposium, the AVMA Annual Meeting, addressing and attending the Peter Piper Conference, and addressing and attending the Orientation for the Class of 2020 entering the College of Veterinary Medicine at U of F all within a few weeks.

Each occasion allowed me to be surrounded by the most amazing people in the world, my present and future colleagues. I was also reminded of all the amazing things that we do in this profession and why each of us, no matter the struggle, rises to the challenge. In addition, I was also reminded that we all made this choice, a choice to serve our fellow humans as we serve the animals that are critical to their lives.

The remainder of 2016 will see the FVMA produce two world class CE events, The Gulf-Atlantic Veterinary Conference, and the FAEP Promoting Excellence Symposium. In addition, we will be positioning ourselves to protect our profession by looking forward to the 2017 Legislative session in Tallahassee to ensure our profession is protected and our visions advanced.

In closing I again will state I am humbled at the privilege to serve and represent our members.

Respectfully Yours,

Richard C. Sutliff, DVM

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

In Remembrance

ROBERT STOTTLEMYER, DVM Dr. Robert “Bob/Doc” STOTTLEMYER, 58, of Land O’ Lakes, Fla., passed away unexpectedly on June 29, 2016.

Dr. Bob was the owner of All Creatures Animal Hospital in Lutz, Fla., for 30 years and a member of the FVMA since 1996.

Born in Pittsburgh, Pa., Dr. Bob moved to Florida in 1986.

He was a graduate of The Ohio State University College of Veterinary Medicine.

He enjoyed visiting national parks and had a love for landscape photography, and was respected as a leader. His colleagues, family and friends enjoyed his great sense of humor.

Dr. Stottlemyer is survived by his loving wife of 35 years, Terry; sons, Justin and Kyle; sister, Joann & brother-in-law Steve Waldner; and his extended All Creatures Animal Hospital family.

BENJAMIN H. RAWLS, JR., DVM Dr. Benjamin H. Rawls, Jr., prominent Daytona veterinarian, passed away on July 7, after fighting cancer for two decades. He was 74 years old.

Dr. Rawls practiced veterinary medicine in Daytona for 45 years, and at the time of his passing, was a retired member of the FVMA. He was the first veterinarian in Daytona to offer small incision cataract surgery, and improved the sight of more than 3,000 animals. An excellent diagnostician and surgeon, he was a pioneer in performing complicated facial reconstruction on Shar-Peis, the Chinese dog breed known for its distinctive features of deep wrinkles.

Dr. Rawls was loved by his clients and respected by his colleagues, and was known to never turn a client away because of inability to pay.

He earned degrees from Daytona Beach Junior College (AA '62), the University of Florida (BS '64), and received

his Doctorate of Veterinary Medicine degree from Auburn University in 1968. Throughout his educational career, he was honored for his leadership and scholarship, and was an active community member as a professional. He was a long-time member of the Volusia County Animal Control Board and served as president of the Volusia County Veterinary Medical Association.

Dr. Rawls is survived by son, Charles (Celena) of Monroe, Ga; and brothers, Andrew (Malinda) of Holly Hill and John (Linda) of Dozier, Ala. He was predeceased by his wife, Frances Fretwell Rawls and a son, William Stanley.

LEONARD ANTHONY KRAMAR, DVM Dr. Leonard A. Kramar of Ocala, Fla. Passed away within two days of his beloved wife Barbara’s passing, on April 24, 2016. He was a retired member of the FVMA. Dr. and Mrs. Kramar owned and operated College Road Animal Clinic in Ocala for 43 years.

He was also the veterinarian for all the animals at Silver Springs for many years.

An Air Force veteran of the Korean War, Dr. Kramar gradu‑ ated from veterinary college at Pennsylvania State University.

Originally from Pennsylvania, he moved to Florida in the late fifties after graduation.

Dr. Kramar is survived by stepson, Woody Hunt; and step‑ daughter, Sunny Varney.

In This Issue 3 | In Remembrance 13 | 2016 TGAVC Invitation 5 | Member Spotlights 20 | New Guidance for Pets exposed to Rabies When They Are Overdue Their Vaccine 6 | Meet Our President 10 | 12th Annual Promoting Excellence Symposium 22 | Scheduled Drugs in Veterinary Practice 26 | Practice Pulse 12 | Class of 2020 Orientation 30 | Classified Advertisements WWW.FVMA.ORG |

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MEMBER SPOTLIGHTS DR. JENIFER CHATFIELD – AVMA VETERINARY FELLOW

The FVMA’s Disaster Preparedness Committee Co-Chair & One Health Committee Chair Is One of Three AVMA Fellows Chosen to Provide Scientific Counsel to Members of Congress on animal and public health policy Dr. Jenifer Chatfield of Dade City, Fla. will be based in Washington, D.C. for a year, after she was chosen by the American Veterinary Medical Association (AVMA) as one of three veterinarians to serve in the 2016-2017 AVMA Fellowship Program. AVMA fellows spend the year in the capital providing scientific counsel.

The AVMA says the three doctors will use their scientific expertise to shape federal policy on issues that impact animal and public health.

The two other AVMA fellows who will join Dr. Chatfield in Washington are Dr. Chelsey Shivley of Colorado, and Dr. Taylor Winkleman from California.

AVMA says the fellows will serve as full-time staff in a congressional office or on a congressional committee, advising policymakers on a wide range of pressing issues, such as food

safety, public health, animal welfare, research and small business issues.

Dr. Chatfield is the current Chair of the FVMA’s One Health Committee and CoChair of the FVMA's Disaster Preparedness Committee.

She is a board-certified zoo veterinarian, and is the staff veterinarian at 4J Conservation Center of Dade City. She is also an instructor for FEMA and the Department of Homeland Security’s agroterrorism courses.

Dr. Chatfield served the Florida Department of Health as veterinary and agricultural liaison for the zoonotic and vectorborne disease program, and remains a member of the state’s Medical Reserve Corps.

Dr. Chatfield was awarded the Gold Star Award by the FVMA in 2012.

DR. KELLI SANDERS PROVIDES A PRO

BONO SERVICE FOR THE HUMANE SOCIETY

Dr. Kelli Sanders (front center) plus staff at Shores Animal Hospital; Joy (left), Alachua County Humane Society Adoption Coordinator; Tracey (right), Red's Foster Parent.

Dr. Kelli Sanders at Shores Animal Hospital in Gainesville recently performed a pro bono leg amputation on Red, a stray dog brought into the Alachua County Humane Society. The dog had a leg injury that was not allowed to heal.

Red was in significant pain and the Humane Society could not put him up for adoption in the condition that he was in. They could WWW.FVMA.ORG |

THE FVMA |

not afford the veterinary ser v ices required either, so they reached out to Shores Animal Hospital, with whom they had maintained a strong relationship.

Dr. Sanders is a skilled small animal surgeon, and she successfully removed Red’s right front leg to lessen his pain and improve his quality of life. The doctor’s kindness gave Red a new lease on life and he was adopted shortly thereafter, into a loving forever home.

A release from Lacey Bacchus, Director of Marketing, reveals that an adoption ceremony was held at the animal hospital with guests from the Alachua County Humane Society and the adoption family in attendance, and expresses the gratefulness of both parties for Dr. Sanders' skill and Shores Animal Hospital’s willingness to provide this service at no cost.

Dr. Sanders’ expertise in pet orthopedic surgeries include bone fracture repair, luxating patella surgery, toe amputation, cranial cruciate repair, jaw fracture repair and mandible resection. She also has expertise in soft tissue surgeries.

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MEET OUR PRESIDENT

RICHARD C. SUTLIFF, DVM FVMA President | 2016-2017

On his installation as president of the FVMA, Dr. Richard C. Sutliff spoke of three other veterinarians who had inspired him in his professional practice, saying he treasured the roles they played in instilling the qualities that resulted in his being a dedicated veterinarian.

He expressed deep gratitude for their mentorship and the excellent examples of passion and commitment they provided.

The late Dr. Paul Nicoletti, who passed away in April, 2016, demonstrated the power of continual outreach, he said; the late Dr. Stephen Shores, who before his passing in September 2015, served as a colleague on the FVMA Executive Board, demonstrated the immense power of passion; and Dr. Russell Snyder was a benefactor providing valuable guidance and historical insight.

The installation of the new FVMA President was held on April 14, 2016, during the FVMA’s 87th Annual FVMA Conference, which was held in Tampa, Fla., at the Tampa Marriott Waterside Hotel & Marina.

After his first quarter serving as the head of the Association, it has become clear that as he spoke in April, Dr. Sutliff was signaling his leadership vision to the more than 5,000 veterinarian and veterinary care team professional members of the FVMA. Richard C. “Rick” Sutliff, DVM, of Jacksonville, Fla. told his colleagues the opportunity to serve in the capacity of president was an honor which he deeply treasured, while letting all know that he and the FVMA were looking ahead to an intensive year of service to the veterinary medical profession.

From Ohio to Duval County, FL

Dr. Sutliff grew up in a small town on the west side of Cleveland, Ohio.

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Soccer, competitive sailboat racing, and watersports filled his leisure time while he attended honors classes in school.

Undergraduate studies were completed at New College of Florida and Morehead State University in Kentucky, with his

area of concentration being Organic Chemistry. Dr. Sutliff ’s path to the veterinary profession was not a direct one. Business, and specifically insurance, was his first profession, focusing on underwriting equine mortality insurance and equine farm coverages. He was based

in Louisville, KY at that time. After seven years, he relocated to Jacksonville, Fla. to participate in the start-up of a specialized government contractor focusing on the transportation of military equipment.

In 1993, the decision to pursue his Doctorate of Veterinary Medicine degree found Dr. Sutliff working as an emergency veterinary technician.

He obtained a position as adjunct faculty in the chemistry department of the University of North Florida and undertook advanced biology and chemistry classes as he focused on his goal.

In April 1995, at the age of 37, he received his letter informing him he had succeeded in being admitted to the University of Florida College of Veterinary Medicine (UF CVM).

Dr. Sutliff received his DVM with Honors in 1999. Following two years of practicing emergency medicine in North Chicago, he and his family returned to Jacksonville where he became the Medical Director of the Scott Mill Animal Hospital in 2002, and subsequently purchased the practice in 2003, which he has operated with his wife Kay to present.

RICHARD C. SUTLIFF, DVM FVMA President | 2016-2017

The Sutliff ’s are parents of Alicia, their 26-year-old daughter who serves in the US Navy, and son, Blake, a junior studying Physics and Electrical Engineering.

In the Pursuit of Benefitting Humans and Animals

Encouragement from his veterinary colleagues to become active in organized veterinary medicine led Dr. Sutliff to service of the profession as secretary of the Jacksonville Veterinary Medical Society (JVMS) from 2004 to 2006. He was vice president from 2007-2008, and was elected president of the JVMS in 2008.

During that period, he was involved with negotiating proper reimbursement for practices issuing county rabies tags under that program, and rewriting of the Jacksonville Pet Ordinance, undertaken by the JVMS. Veterinarians in Northeast Florida selected him in 2010, to serve as the District 2 Representative on the FVMA Executive Board.

Dr. Sutliff served a year as president-elect of the FVMA in 2015. In addition, he is a founding member of the UF CVM Dean’s Circle of Excellence and was a member of the College Admissions Committee from 2012 to 2015.

The FVMA President credits his interest in scientific truths for guiding him to veterinary medicine. “My interests and education always was centered on the underlying scientific truths of the world and how I might be able to employ my education to benefit others.” he says, “Veterinary medicine provided a platform where I can employ my education in a varied and exciting profession that benefits both humans and animals.” He continues, “I enjoy my practice as a Veterinarian because I have a daily opportunity WWW.FVMA.ORG |

THE FVMA |

to educate my clients, improving their pets lives and health, and the owners lives.”

Dr. Sutliff heads up a dedicated team at Scott Mill Animal Hospital, which is a complete medical, dental, surgical, grooming and boarding facility. The hospital has been serving the Mandarin area community of Jacksonville since 1978.

FVMA Advocate had the opportunity to interview the FVMA President on his leadership role in the Association in 2016-2017.

What are your goals as president of the FVMA? My goal as FVMA President is twofold: The first is to give back to a profession that has so enriched my life. The second is after serving for many years on the Executive Board and participating in placing the FVMA on a more solid financial foundation, it is time to focus our association to provide additional member benefits. These include investment in focused regional CE for our Practices Support Staff, and focused outreach to the public that our industry serves educating and promoting how our members support animal health.

Please describe your overall vision for the Association into the future.

The FVMA has reached a milestone in its growth. With the fiduciary responsibility provided by recent leadership we are financially strong. This strength opens opportunities into the

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future to solidify our actions and direct support for our present and future practitioners. Quality support in the Florida Legislature places the FVMA in position to provide robust defense of our industry against legislative initiatives, no matter how wellintentioned, that negatively impact our ability as veterinarians to protect both animal health and human health. Technology implementation to support our membership and our clients is another area that now necessitates financial investment for which we are properly positioned.

What is your philosophy about service, and in organized veterinary medicine specifically?

I originally joined the FVMA in its student chapter in 1996 when I was attending the University of Florida College Of Veterinary Medicine. I have always believed in serving the organizations that Dr. Sutliff & Mrs. Kay Sutliff support my personal activities. I was lucky to have had my father as an example. He participated in many organizations from the United States Power Squadron to as I assumed the additional responsibilities of representing our a National Group of Retired WW2 Sailors to his Condominium members as President. In preparation for this impact on my Association. Each of these he eventually was promoted to the practice I had hired a new graduate in 2014. Dr. Zack Moore top leadership position. In my Veterinary service I had a strong joined our team to work with me and my other associate, Dr. local mentor in the Jacksonville area that demonstrated through Natalie Hashey who is also a graduate of U of F class of 1999. his own actions and encouragement that our industry is one full Dr. Moore was previously an employee in my practice’s kennels of colleagues and not competitors. That we have common goals and as a technician before being accepted into the University of that need uncommon effort. I was taught that it takes a few to Georgia for veterinary school. We both had the long-term vision help motivate many and my hope is that I may play a small part of him rejoining my practice upon graduation. The timing was in helping that come to fruition. perfect and after a year of us working together, he, Dr. Hashey and my outstanding team have been instrumental in ensuring the How are your extra duties as president impacting your continuity of quality care for my clients.

practice as a vet?

The travel and extended time away from my practice is something that I was aware could become potential problems

What are the important issues for Florida veterinarians from your point of view? And why are they important?

President Rick Sutliff with his wife Kay and Executive Board colleagues Jim Brechin (thrid from left), Don Morgan (extreme right), and past president Geoffrey Gardner (second from right).

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The protection of our industry from individuals and groups that wish to devalue it in the name of being more humane. Each veterinarian took an oath upon their entrance into this hallowed profession and each of us has a path to follow. Sadly sometime the public, either being guided or misguided, promotes that animals have the right to care and that right should supersede the need for someone to be properly compensated for their educations, expertise, and efforts. Public education as to why animal welfare is the central focus of all veterinarians, but appropriate compensation is not diametrically opposed to that effort, is going to be key to counteract the diminished wellness of our members and our profession.

What are your ideas about addressing those issues?

Public outreach with quality, focused education on the role of Veterinarians in One Health and local Animal and Human health along with reminding the public about the professional training and its value that veterinarians supply.

What is the FVMA’s role in addressing the issues you speak of?

Dr. Sutliff at the FVMA's 87th Annual Conference with former Executive Board Space Coast Representative, Dr. Christine Storts and Dr. Michael Epperson.

Production of both digital and printed materials to promote the proper role of the veterinarian in population control, public health, animal health, and discussing the difficult role we take on with the public. In addition, provide wellness outreach to practitioners.

What message would you like to leave the membership?

I am honored to be a member of this profession. The fact that our members have impact on a great multitude of activities that directly impact the residents of our state, most unknown to the general public, is a failure of our own self-promotion. The veterinarian’s role in One Health and specifically in Public Health needs to be shouted from the rooftops. The role in safety of the food supply deserves the same treatment.

Preventing zoonotic disease and bioterrorism is every veterinarian’s daily job, but the public remains ignorant.

Dr. Sutliff joined students of UF CVM class of 2020 for orientation.

Veterinarians are leaders. This is not a choice you make today, it is the choice you made many years ago!

We are the leaders on the HumanAnimal Bond!

We are the leaders on Safety in many critical areas of the human food supply!

We are the leaders in Research to better both animal’s lives and human lives!

We must stand up and demand that those roles be respected and not allow anyone to usurp our position!

Dr. Sutliff joined students of UF CVM class of 2020 for orientation.

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CLASS OF 2020 ORIENTATION 111 New Veterinary Medical Students Begin Their Journey at UF CVM

Richard Sutliff, DVM (left), speaking to students of the Class of 2020 alongside Dr. Alex Thomasson, Co-chair of the College Advisory Committee, and Dean James Lloyd (back to the camera).

The University of Florida College of Veterinary Medicine welcomed its class of 2020 at student’s orientation on Monday, August 15, when 111 new veterinary medical students came together and got a first comprehensive view of all that awaits them in the next four years.

The UF CVM Class of 2020 includes 88 Florida residents and 24 non-sponsored students. During the summer, class members undertook some on-line training and begun their classes on August 22.

The FVMA was represented at the orientation and FLE by president, Richard C. Sutliff, D.V.M., on hand Later that week, orientation was followed up by the to welcome these new members to the FVMA and First Year Leadership Experience (FLE) which gave introduce them to organized veterinary medicine. the students an opportunity to get to know each other On behalf of the members of the FVMA, Dr. Sutliff and various faculty, staff and administrators. The brought gifts for the new students members and gave experience, featured a variety of fun and motivational a presentation to students which detailed the work of team-building activities. the Association.

Class of 2020 with Drs. Ginn and House - Go Gators!

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It’s a soft chew.

Kills both fleas and ticks.

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Now a pprov to kill m ed ore ticks!

NexGardTM (afoxolaner) is the protection you asked for, and patients will beg for.

NexGard is FDA-approved to kill fleas, prevent flea infestations, and kill Black-Legged (deer) ticks, Lone Star ticks and American Dog ticks. NexGard is available only with a veterinarian’s prescription, and features anti-diversion technology monitored by Pinkerton® Consulting & Investigations.

NexGard and FRONTLINE VET LABS are trademarks of Merial. ®PINKERTON is a registered trademark of Pinkerton Service Corporation. ©2014 Merial Limited, Duluth, GA. All rights reserved. NEX14TTRADEAD (06/14).

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IMPORTANT SAFETY INFORMATION: For use in dogs only. The most common adverse reaction is vomiting. Other adverse reactions reported are dry/flaky skin, diarrhea, lethargy, and anorexia. The safe use of NexGard in pregnant, breeding, or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures.

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This program 532-26211 is approved by the AAVSB RACE to offer a total of 47.00 CE Credits (35.00 max) being available to any one veterinarian: and/or 47.00 Veterinary Technician CE Credits (35.00 max). This RACE approval is for the subject matter categorie(s) of: Category One: Scientific Category Three: Non-Scientific-Practice Management/Professional Development using the delivery method(s) of: Seminar/LectureLab/Wet Lab. This approval is valid in jurisdictions which recognize AAVSB RACE; however, participants are responsible for ascertaining each board's CE requirements.

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New Guidance FOR PETS EXPOSED TO RABIES That Are Overdue Their Vaccine

New guidance were recently released for pets overdue for their rabies vaccinations that have experienced rabies exposure. The 2016 Compendium of Animal Rabies Prevention and Control from the National Association of State Public Health Veterinarians released in April of this year, carries the new guidance.

The 2016 Compendium replaces all previous versions, and serves as a basis for animal rabies prevention and control programs throughout the United States. It facilitates standardization of procedures among jurisdictions, thereby contributing to an effective national rabies control program. The co-chair of the compendium committee, Dr. Catherine M. Brown, has described the compendium as a series of best practices that jurisdictions can choose to follow.

The compendium’s recommendations do not supersede state and local laws or requirements, but it contains principles of rabies prevention and control, recommendations for parenteral vaccinations procedures as well as the animal rabies vaccines that are licensed by the USDA and marketed in the US, along with the contact information for vaccine manufacturers.

The changes in the 2016 version of the compendium include changes to the recommended management of dogs and cats exposed to rabies that are either unvaccinated or overdue for booster vaccination, reduction of the recommended 6-month quarantine period for certain species, and updates the list of marketed animal rabies vaccines.

Readers may download a copy of the 2016 Compendium from the web link: http://nasphv.org/Documents/ NASPHVRabiesCompendium.pdf The new guidance relating to rabies exposure in pets that are overdue for the rabies vaccine is included at Part 1, section B, “Prevention and control methods in domestic and confined animals” at subsection 5 entitled “Postexposure management” which we have reproduced below.

In summary, the new guide recommends that cats and dogs that are exposed to rabies and are overdue for a vaccine can have a booster shot followed by an observation period rather than be subject to quarantine or euthanasia.

It also advises reducing the quarantine period from six months to four for unvaccinated cats and dogs exposed to rabies.

Taken from: Public Veterinary Medicine: Public Health Compendium of Animal Rabies Prevention and Control, 2016 5. Postexposure management. This section refers to any animal exposed (see Part I. A. 2. Rabies virus exposure) to a confirmed or suspected rabid animal. Wild mammalian carnivores, skunks, and bats that are not available or suitable for testing should be regarded as rabid. The rationale for observation, confinement, or strict quarantine periods of exposed animals despite previous vaccination is based in part on the potential for overwhelming viral challenge, incomplete vaccine efficacy, improper vaccine administration, variable host immunocompetence, and immunemediated death (ie, early death phenomenon).13,55–57 a) Dogs, cats, and ferrets. Any illness in an exposed animal should be reported immediately to the local health department.

If signs suggestive of rabies develop (eg, paralysis or seizures), the animal should be euthanized, and the head or entire brain (including brainstem) should be submitted for testing (see Part I. A. 10. Rabies diagnosis).

(1) Dogs, cats, and ferrets that are current on rabies vaccination should immediately receive veterinary medical care for assessment, wound cleansing, and booster vaccination. The animal should be kept under the owner’s control and observed for 45 days.

(2) Dogs, cats, and ferrets that have never been vaccinated

CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.

Description: NEXGARD™ (afoxolaner) is available in four sizes of beef-flavored, soft chewables for oral administration to dogs and puppies according to their weight. Each chewable is formulated to provide a minimum afoxolaner dosage of 1.14 mg/lb (2.5 mg/kg). Afoxolaner has the chemical composition 1-Naphthalenecarboxamide, 4-[5[3-chloro-5-(trifluoromethyl)-phenyl]-4, 5-dihydro-5-(trifluoromethyl)-3-isoxazolyl]-N[2-oxo-2-[(2,2,2-trifluoroethyl)amino]ethyl.

Indications: NEXGARD kills adult fleas and is indicated for the treatment and prevention of flea infestations (Ctenocephalides felis), and the treatment and control of Black-legged tick (Ixodes scapularis), American Dog tick (Dermacentor variabilis), and Lone Star tick (Amblyomma americanum) infestations in dogs and puppies 8 weeks of age and older, weighing 4 pounds of body weight or greater, for one month.

Dosage and Administration: NEXGARD is given orally once a month, at the minimum dosage of 1.14 mg/lb (2.5 mg/kg).

Dosing Schedule: Body Weight 4.0 to 10.0 lbs.

10.1 to 24.0 lbs.

24.1 to 60.0 lbs.

60.1 to 121.0 lbs.

Over 121.0 lbs.

Afoxolaner Per Chewable (mg)

Chewables Administered

11.3 One 28.3 One 68 One 136 One Administer the appropriate combination of chewables

NEXGARD can be administered with or without food. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes to ensure that part of the dose is not lost or refused. If it is suspected that any of the dose has been lost or if vomiting occurs within two hours of administration, redose with another full dose. If a dose is missed, administer NEXGARD and resume a monthly dosing schedule.

Flea Treatment and Prevention: Treatment with NEXGARD may begin at any time of the year. In areas where fleas are common year-round, monthly treatment with NEXGARD should continue the entire year without interruption.

To minimize the likelihood of flea reinfestation, it is important to treat all animals within a household with an approved flea control product.

Tick Treatment and Control: Treatment with NEXGARD may begin at any time of the year (see Effectiveness).

Contraindications: There are no known contraindications for the use of NEXGARD. Warnings: Not for use in humans. Keep this and all drugs out of the reach of children. In case of accidental ingestion, contact a physician immediately.

Precautions: The safe use of NEXGARD in breeding, pregnant or lactating dogs has not been evaluated.

Use with caution in dogs with a history of seizures (see Adverse Reactions).

Adverse Reactions: In a well-controlled US field study, which included a total of 333 households and 615 treated dogs (415 administered afoxolaner; 200 administered active control), no serious adverse reactions were observed with NEXGARD. Over the 90-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported at an incidence of > 1% within any of the three months of observations are presented in the following table. The most frequently reported adverse reaction was vomiting. The occurrence of vomiting was generally self-limiting and of short duration and tended to decrease with subsequent doses in both groups. Five treated dogs experienced anorexia during the study, and two of those dogs experienced anorexia with the first dose but not subsequent doses.

Table 1: Dogs With Adverse Reactions.

Treatment Group Afoxolaner

Oral active control

N1

% (n=415)

N2

% (n=200)

Vomiting (with and without blood)

17

4.1

25

12.5

Dry/Flaky Skin

13

3.1

2

1.0

Diarrhea (with and without blood)

13

3.1

7

3.5

Lethargy

7

1.7

4

2.0

Anorexia

5

1.2

9

4.5

1 Number of dogs in the afoxolaner treatment group with the identified abnormality.

2 Number of dogs in the control group with the identified abnormality.

In the US field study, one dog with a history of seizures experienced a seizure on the same day after receiving the first dose and on the same day after receiving the second dose of NEXGARD. This dog experienced a third seizure one week after receiving the third dose. The dog remained enrolled and completed the study. Another dog with a history of seizures had a seizure 19 days after the third dose of NEXGARD. The dog remained enrolled and completed the study. A third dog with a history of seizures received NEXGARD and experienced no seizures throughout the study.

To report suspected adverse events, for technical assistance or to obtain a copy of the MSDS, contact Merial at 1-888-637-4251 or www.merial.com/ nexgard. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/ AnimalVeterinary/SafetyHealth.

Mode of Action: Afoxolaner is a member of the isoxazoline family, shown to bind at a binding site to inhibit insect and acarine ligand-gated chloride channels, in particular those gated by the neurotransmitter gamma-aminobutyric acid (GABA), thereby blocking pre- and post-synaptic transfer of chloride ions across cell membranes.

Prolonged afoxolaner-induced hyperexcitation results in uncontrolled activity of the central nervous system and death of insects and acarines. The selective toxicity of afoxolaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines’ GABA receptors versus mammalian GABA receptors.

Effectiveness: In a well-controlled laboratory study, NEXGARD began to kill fleas four hours after initial administration and demonstrated >99% effectiveness at eight hours.

In a separate well-controlled laboratory study, NEXGARD demonstrated 100% effectiveness against adult fleas 24 hours post-infestation for 35 days, and was ≥ 93% effective at 12 hours post-infestation through Day 21, and on Day 35. On Day 28, NEXGARD was 81.1% effective 12 hours post-infestation. Dogs in both the treated and control groups that were infested with fleas on Day -1 generated flea eggs at 12- and 24-hours post-treatment (0-11 eggs and 1-17 eggs in the NEXGARD treated dogs, and 4-90 eggs and 0-118 eggs in the control dogs, at 12- and 24hours, respectively). At subsequent evaluations post-infestation, fleas from dogs in the treated group were essentially unable to produce any eggs (0-1 eggs) while fleas from dogs in the control group continued to produce eggs (1-141 eggs).

In a 90-day US field study conducted in households with existing flea infestations of varying severity, the effectiveness of NEXGARD against fleas on the Day 30, 60 and 90 visits compared with baseline was 98.0%, 99.7%, and 99.9%, respectively.

Collectively, the data from the three studies (two laboratory and one field) demonstrate that NEXGARD kills fleas before they can lay eggs, thus preventing subsequent flea infestations after the start of treatment of existing flea infestations.

In well-controlled laboratory studies, NEXGARD demonstrated >94% effectiveness against Dermacentor variabilis and Ixodes scapularis, 48 hours post-infestation, and against Amblyomma americanum 72 hours post-infestation, for 30 days.

Animal Safety: In a margin of safety study, NEXGARD was administered orally to 8- to 9-week-old Beagle puppies at 1, 3, and 5 times the maximum exposure dose (6.3 mg/kg) for three treatments every 28 days, followed by three treatments every 14 days, for a total of six treatments. Dogs in the control group were sham-dosed. There were no clinically-relevant effects related to treatment on physical examination, body weight, food consumption, clinical pathology (hematology, clinical chemistries, or coagulation tests), gross pathology, histopathology or organ weights. Vomiting occurred throughout the study, with a similar incidence in the treated and control groups, including one dog in the 5x group that vomited four hours after treatment.

In a well-controlled field study, NEXGARD was used concomitantly with other medications, such as vaccines, anthelmintics, antibiotics (including topicals), steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of NEXGARD with other medications.

Storage Information: Store at or below 30°C (86°F) with excursions permitted up to 40°C (104°F).

How Supplied: NEXGARD is available in four sizes of beef-flavored soft chewables: 11.3, 28.3, 68 or 136 mg afoxolaner. Each chewable size is available in color-coded packages of 1, 3 or 6 beef-flavored chewables.

NADA 141-406, Approved by FDA Marketed by: Frontline Vet Labs™, a Division of Merial Limited.

Duluth, GA 30096-4640 USA Made in Brazil.

1050-4493-02 Rev. 4/2014

™NexGard and FRONTLINE VET LABS are trademarks of Merial. ©2014 Merial. All rights reserved.

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should be euthanized immediately. There are currently no USDA-licensed biologics for post exposure prophylaxis of previously unvaccinated domestic animals, and there is evidence that the use of vaccine alone will not reliably prevent the disease in these animals.58 If the owner is unwilling to have the animal euthanized, the animal should be placed in strict quarantine for 4 (dogs and cats) or 6 (ferrets) months. Strict quarantine in this context refers to confinement in an enclosure that precludes direct contact with people and other animals. A rabies vaccine should be administered at the time of entry into quarantine to bring the animal up to current rabies vaccination status. Administration of vaccine should be done as soon as possible. It is recommended that the period from exposure to vaccination not exceed 96 hours.59,60 If vaccination is delayed, public health officials may consider increasing the quarantine period for dogs and cats from 4 to 6 months, taking into consideration factors such as the severity of exposure, the length of delay in vaccination, current health status, and local rabies epidemiology.

(3) Dogs and cats that are overdue for a booster vaccination and that have appropriate documentation of having received a USDA-licensed rabies vaccine at least once previously should immediately receive veterinary medical care for assessment, wound cleansing, and booster vaccination. The animal should be kept under the owner’s control and observed for 45 days.39 If booster vaccination is delayed, public health officials may consider increasing the observation period for the animal, taking into consideration factors such as the severity of exposure, the length of delay in booster vaccination, current health status, and

local rabies epidemiology.

(4) Dogs and cats that are overdue for a booster vaccination and without appropriate documentation of having received a USDAlicensed rabies vaccine at least once previously should imme‑ diately receive veterinary medical care for assessment, wound cleansing, and consultation with local public health authorities. (a) The animal can be treated as unvaccinated, immediately given a booster vaccination, and placed in strict quarantine (see Part I. B. 5. a) (2)). (b) Alternatively, prior to booster vaccination, the attending veterinarian may request guidance from the local public health authorities in the possible use of prospective serologic moni‑ toring. Such monitoring would entail collecting paired blood samples to document prior vaccination by providing evidence of an anamnestic response to booster vaccination. If an adequate anamnestic response is documented, the animal can be consid‑ ered to be overdue for booster vaccination (see Part I. B. 5. a) (3)) and observed for 45 days.39 If there is inadequate evidence of an anamnestic response, the animal is considered to have never been vaccinated and should be placed in strict quarantine (see Part I. B. 5. a) (2)).

(5) Ferrets that are overdue for a booster vaccination should be evaluated on a case-by-case basis, taking into consideration fac‑ tors such as the severity of exposure, time elapsed since last vac‑ cination, number of previous vaccinations, current health status, and local rabies epidemiology, to determine need for euthanasia or immediate booster vaccination followed by observation or strict quarantine.

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SCHEDULED DRUGS IN VETERINARY PRACTICE The FVMA from time to time receives questions about scheduled drugs and rules that apply to the different schedules.

Just recently, a member veterinarian called the FVMA Help Line for answers to a question relating to this issue, for as he put it, “the vets in the areas can’t agree on what is correct.”

Recognizing that there may be genuine confusion about handling and dispensing scheduled drugs, we decided a look at the rules governing the use of these substances in veterinary practice would be of value to members.

Schedules of Controlled Substances

The drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. A complete list of the schedules is published annually on an updated basis in the DEA regulations, Title 21 of the Code of Federal Regulations, Sections 1308.11 through 1308.15.

Schedule I

All drugs listed in Schedule I have no currently accepted medical use in treatment in the United States and therefore may not be prescribed, administered, or dispensed for medical use.

Substances in this schedule have no currently accepted medical use in treatment in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin; lysergic acid diethylamide (LSD); marijuana (cannabis); peyote; methaqualone; and methylene-dimethoxy-methamphetamine ("ecstasy").

The CSA allows for bona fide research with controlled substances in Schedule I, provided that the FDA has determined the researcher to be qualified and competent, and provided further that the FDA has determined the research protocol to be meritorious. Researchers who meet these criteria must obtain a separate registration to conduct research with a Schedule I controlled substance.

Schedule II

Drugs listed in Schedule II have some accepted medical use and therefore may be prescribed, administered, or dispensed for medical use.

Substances in this schedule have a high potential for abuse with severe psychological or physical dependence. Examples of single entity Schedule II narcotics include morphine, codeine, and 22 | FVMA ADVOCATE

opium. Other Schedule II narcotic substances and their common name-brand products include: hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®), and fentanyl (Sublimaze® or Duragesic®). Examples of Schedule II stimulants include amphetamine (Dexedrine® or Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®). Other Schedule II substances include: cocaine, amobarbital, glutethimide, and pentobarbital.

Schedule III

Drugs listed in Schedule III have some accepted medical use and therefore may be prescribed, administered, or dispensed for medical use.

Substances in this schedule have a potential for abuse less than substances in Schedules I or II. Examples of Schedule III narcotics include combination products containing less than 15 milligrams of hydrocodone per dosage unit (i.e., Vicodin®) and products

containing not more than 90 milligrams of codeine per dosage unit (i.e., Tylenol with codeine®). Examples of Schedule III nonnarcotics include benzphetamine (Didrex®), phendimetrazine, dronabinol (Marinol®), ketamine, and anabolic steroids such as oxandrolone (Oxandrin®).

Schedule IV

Drugs listed in Schedules IV have some accepted medical use and therefore may be prescribed, administered, or dispensed for medical use.

Substances in this schedule have a lower potential for abuse relative to substances in Schedule III. An example of a Schedule IV narcotic is propoxyphene (Darvon® and Darvocet-N 100®).

Other Schedule IV substances include alprazolam (Xanax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).

Schedule V

Drugs listed in Schedule V have some accepted medical use and therefore may be prescribed, administered, or dispensed for medical use.

Substances in this schedule have a lower potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotic and stimulant drugs. These are generally used for antitussive, antidiarrheal and analgesic purposes. Examples include cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, and Phenergan with Codeine®).

Registration Requirements

A practitioner or entity that handles controlled substances must be registered with the DEA. DEA registration grants practitioners federal authority to handle controlled substances.

However, a DEA registered practitioner may only engage in those activities that are authorized under state law for the jurisdiction in which the practice is located.

When federal law or regulations differ from state law or regulations, the practitioner is required to abide by the more stringent aspects of both the federal and state requirements. In many cases, state law is more stringent than federal law, and must be complied with in addition to federal law. Practitioners should be certain they understand their state as well as DEA controlled substance regulations.

Application for Registration

To obtain a DEA registration, a practitioner must apply using a DEA Form 224. Applicants may submit the form by hard copy or online. Complete instructions accompany the form. To obtain the application, DEA may be contacted at: • DEA Website: www.DEAdiversion.usdoj.gov • Any DEA field office

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• DEA Headquarters’ Registration Section in Washington, D.C. at 1-800-882-9539 The DEA Form 224 may be completed online or in hard copy and mailed to: Drug Enforcement Administration Attn: ODR P.O. Box 2639 Washington, D.C. 22152-2639

Certificate of Registration

Your DEA Certificate of Registration (DEA Form 223) must be maintained at the registered location in a readily retrievable manner and kept available for official inspection.

The CSA requires that a separate registration be obtained for each principal place of business or professional practice where controlled substances are manufactured, distributed, or dispensed. DEA has historically provided an exception that a practitioner who is registered at one location, but also practices at other locations, is not required to register separately for any other location at which controlled substances are only prescribed.

If the practitioner maintains supplies of controlled substances, administers, or directly dispenses controlled substances at the separate location, the practitioner must obtain a separate DEA registration for that location. The exception applies only to a secondary location within the same state in which the practitioner maintains his/her registration. DEA individual practitioner registrations are based on state authority to dispense or conduct research with respect to controlled substances. Since a DEA registration is based on a state license, it cannot authorize controlled substance dispensing outside that state. Hence, the separate registration exception applies only to locations within the same state in which practitioners have their DEA registrations.

A duplicate Certificate of Registration may be requested online on the DEA’s website, www.DEAdiversion.usdoj.gov, as follows: •

Practitioner registrations must be renewed every three years. Renewal registrations use DEA Form 224a, Renewal Application for DEA Registration. The cost of the registration is indicated on the application form.

A renewal application is sent to the registrant approximately 45 days before the registration expiration date. The renewal application is sent to the address listed on the current registration certificate. If the renewal form is not received within 30 days before the expiration date of the current registration, the practitioner should contact the DEA registration office for their state, or DEA Headquarters at 1-800-882-9539, and request a renewal registration form.

There are six Field Division Offices in Florida for the DEA Miami Division:

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FLORIDA-VETERINARY-MEDICAL-ASSOCIATION | 23

A prescription for a controlled substance must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner on the date when issued. An individual may be designated by the practitioner to prepare prescriptions for the practitioner’s signature.

The practitioner is responsible for ensuring that the prescription conforms to all requirements of the law and regulations, both federal and state.

Who May Issue

The registration renewal application may be completed online at www.DEAdiversion.usdoj.gov, or in hard copy and mailed to: Drug Enforcement Administration Attn: ODR P.O. Box 2639 Washington, D.C. 22152-2639

Change of Business Address

A practitioner who moves to a new physical location must request a modification of registration. A modification of registration can be requested online or in writing to the DEA field office in the state. If the change in address involves a change in state, the proper state-issued license and controlled substances registration must be obtained prior to the approval of modification of the federal registration. If the modification is approved, DEA will issue a new certificate of registration and, if requested, new Schedule II order forms (DEA Form-222, Official Order Form). A Renewal Application for Registration (DEA Form-224a) will only be sent to the registered address on file with DEA. It will not be forwarded.

Termination of Registration

Any practitioner desiring to discontinue business activities with respect to controlled substances must notify the nearest DEA field office in writing. Along with the notification of termination of registration, the practitioner should send the DEA Certificate of Registration and any unused Official Order Forms (DEA Form222) to the nearest DEA field office.

Prescription Requirements

A prescription for a controlled substance must be dated and signed on the date when issued. The prescription must include the patient’s full name and address, and the practitioner’s full name, address, and DEA registration number. The prescription must also include: 1. drug name 2. strength 3. dosage form 4. quantity prescribed 5. directions for use 6. number of refills (if any) authorized 24 | FVMA ADVOCATE

A prescription for a controlled substance may only be issued by a licensed veterinarian who is: 1. Authorized to prescribe controlled substances by the jurisdiction in which the practitioner is licensed to practice 2. Registered with DEA or exempted from registration (that is, Public Health Service, Federal Bureau of Prisons, or military practitioners) 3. An agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution which is registered in lieu of the individual practitioner being registered provided that additional requirements as set forth in the CFR are met.

Schedule II Substances

Schedule II controlled substances require a written prescription which must be signed by the practitioner. There is no federal time limit within which a Schedule II prescription must be filled after being signed by the practitioner.

While some states and many insurance carriers limit the quantity of controlled substance dispensed to a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via a prescription. For Schedule II controlled substances, an oral order is only permitted in an emergency situation.

Refills The refilling of a prescription for a controlled substance listed in Schedule II is prohibited (Title 21 U.S. Code § 829(a)).

Issuance of Multiple Prescriptions for Schedule II Substances An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a schedule II controlled substance provided the following conditions are met: 1. Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice.

2. The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription.

3. The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse.

4. The issuance of multiple prescriptions is permissible under applicable state laws.

5. The individual practitioner complies fully with all other applicable requirements under the Controlled Substances Act and Code of Federal Regulations, as well as any additional requirements under state law.

Facsimile Prescriptions for Schedule II Controlled Substances In order to expedite the filling of a prescription, a prescriber may transmit a Schedule II prescription to the pharmacy by facsimile. The original Schedule II prescription must be presented to the pharmacist for review prior to the actual dispensing of the controlled substance.

animals may be considered by a vet when the health of animals is immediately threatened and suffering or death would result from failure to treat the affected animals.

FDA regulations that address extra-label drug use are con‑ tained in 21 CFR 530. The FDA maintains a list of drugs that are prohibited for extra-label use for food-producing animals (21 CFR 530.41). At a minimum, the following label information is recommended: An updated list of prohibited drugs may be found online at: www.farad.org/eldu/prohibit.asp.

In an emergency, a practitioner may call-in a prescription for a Schedule II controlled substance by telephone to the pharmacy, and the pharmacist may dispense the prescription provided that the quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period. The prescribing practitioner must provide a written and signed prescription to the pharmacist within seven days. Further, the pharmacist must notify DEA if the prescription is not received.

Schedule III-V Substances

A prescription for controlled substances in Schedules III, IV, and V issued by a practitioner, may be communicated either orally, in writing, or by facsimile to the pharmacist, and may be refilled if so authorized on the prescription or by call-in.

Refills Schedule III and IV controlled substances may be refilled if authorized on the prescription. However, the prescription may only be refilled up to five times within six months after the date on which the prescription was issued. After five refills or after six months, whichever occurs first, a new prescription is required.

Facsimile Prescriptions for Schedule III-V Substances Prescriptions for Schedules III-V controlled substances may be transmitted by facsimile from the practitioner or an employee or agent of the individual practitioner to the dispensing pharmacy. The facsimile is considered to be equivalent to an original prescription.

Extra-Label Use of Controlled Substances

The Drug Use Clarification Act of 1994 allows veterinarians extra-label use of controlled substances with certain conditions: Actual use or intended use of a drug in an animal in a manner that is not in accordance with the approved labeling.

This includes, but is not limited to, use in species not listed in the labeling, use for indications (disease and other conditions) not listed in the labeling, use at dosage levels, frequencies, or routes of administration other than those stated in the labeling, and deviation from labeled withdrawal time based on these different uses.

Extra-label use of drugs may only take place within the scope of a valid VCPR (veterinarian/client/patient relationship). Although the FDA has taken legal action against veterinarians responsible for creating violative drug tissue residues in the food supply, especially when they were the result of drugs used contrary to label instruction, extra-label drugs used to treat food-producing WWW.FVMA.ORG |

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PRACTICE GOT A QUESTION? THE FVMA CAN HELP.

One of the benefits of membership in the FVMA is our Helpline, (800) 992-3862, available to members daily, Monday to Friday, 8:00 am to 6:00 pm.

Our Helpline also provides insight to the FVMA staff, of the challenges and concerns of our members.

In this feature we will highlight topics from the questions we received in preceding weeks, in an effort to keep our members up-to-date on current concerns as well as regulatory and legislative changes.

QUESTION:

Can a licensed human massage therapist treat and work on animals?

A: Specifically, 474.202(9), Florida Statutes, states that the practice of veterinary medicine means: “diagnosing the medical condition of animals and prescribing, dispensing, or administering drugs, medicine, appliances, applications, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease thereof; performing any manual procedure for the diagnosis of or treatment for pregnancy or fertility or infertility of animals; or representing oneself by the use of titles or words, or undertaking, offering, or holding oneself out, as performing any of these functions. The term includes the determination of the health, fitness, or soundness of an animal.”

So, for people who are offering animal massages, the issue is whether such services are offered for the treatment, prevention or cure of a wound, fracture, bodily injury, or disease of the animal. If it is offered for any of the preceding purposes, then the person must either be licensed as a veterinarian or be operating under the supervision of a license veterinarian. Also, it is important to note that if a person offering animal massages makes a health status determination or otherwise diagnoses the injury or condition of an animal which they are massaging, then they are also practicing veterinary medicine and must have a veterinary medicine license.

In simplistic terms therefore, if the owner of a pet simply wants to get a pet massage because they think the pet will enjoy it and feel better, then there is no issue with a person operating an animal massage business.

However, if a person brings an animal into an animal massage business and wants the business to determine what is wrong with the pet or to treat an injury, disease or other ailment of the pet, then they must have a licensed veterinarian involved or have a veterinary license themselves.

26 | FVMA ADVOCATE

QUESTION:

I am interested in having a licensed dentist do advanced dental procedures including extractions in my clinic. He has checked with the dental board and they have no problem with it. What are the legalities from the veterinary side? I, of course, would be in charge of all anesthesia, medications, etc.

A: The definition of the term “veterinary medicine” in §474.202(13) includes dentistry. Therefore, anyone performing dental extractions would have to be a veterinarian, or be otherwise exempt under the Veterinary Practice Act. Under §474.203(7), a veterinary aide may “….render auxiliary or supporting assistance under the responsible supervision of a licensed veterinarian….”

The question then becomes whether actually performing the procedure can be interpreted as “rendering auxiliary or supporting assistance.” Although the Board’s rule on delegable tasks does not specifically state what can or can’t be delegated (except for certain vaccinations), the general consensus and understanding is that a veterinary technician can’t perform surgery (i.e. neuter a cat) but they can close up an incision after surgery is completed.

Applying the same logic we are lead to conclude that the non-veterinarian (no matter how eminently qualified) could not perform dental surgery as an aide.

QUESTION:

Our practice is going paperless and we have a question about forms signed by our clients, for example, surgical release form, euthanasia consent form, etc. Can our hard copies be destroyed once they are scanned into the patient’s electronic file or must we keep them as part of the medical record? And should there be a disclaimer on the signed form stating the client understands and accepts that it will be scanned into the electronic record?

A: Rule 61G18-18.002(9) provides that medical records can be kept in an easily retrievable electronic data format. So, as far as the Board of Veterinary Medicine is concerned, electronic medical records are recognized as OK. Scanned copies of surgical release or euthanasia consent forms (or anything else) are OK and the originals

can be destroyed, keeping in mind that they should be destroyed, and not placed in the dumpster where anyone can fish them out.

We are unaware of any requirement by any medical board that the patient (client) must be made aware of the format in which the records are being kept, so no disclaimer would be required.

QUESTION:

Am I obligated to provide emergency care to a walk in non-client, even when they will not pay a deposit? The AVMA states in its code of ethics, “In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering, subsequent to client agreement.”

A: Refusing to establish a veterinarian-client-patient relationship because the owner refuses to pay for services up front is not grounds for disciplinary action before the Florida Board of Veterinary Medicine. There is no state law or other regulation which requires a veterinarian to render emergency medical care to a pet. While this is generally a distasteful subject to the pet owner, since pets are considered property, a vet is entitled to request payment up front for services.

Please note that this is the state law and does not reflect the aspirational requirements of the AVMA. If the AVMA felt that a veterinarian did something wrong, then they could levy their own internal sanction. However, based on your information, there would be no grounds for discipline against the veterinarian’s State of Florida issued veterinary medical license.

QUESTION:

In an article recently written by a veterinarian about groomers, he states it is illegal for groomers to express anal sacs on pets they are grooming. A groomerclient of mine is concerned she is breaking the law. I feel that expressing anal sacs while at the groomers does not mean the groomer is practicing veterinary medicine. Is this correct thinking on my part?

A: The groomer would not be in violation of Chapter 474, Florida Statutes, if she is expressing the anal sacks of a pet as a normal grooming and/or hygiene regiment put in place by the owner or groomer. The groomer would be in violation if she were diagnosing the condition of the pet or otherwise trying to treat an underlying medical condition.

WWW.FVMA.ORG |

THE FVMA |

If however, a groomer attempts to make a medical judgment or is attempting to provide treatment specifically aimed at an underlying illness, he/she would run afoul of the statute.

QUESTION:

If prescription diets require a prescription, am I required to have a valid client-patient relationship to sell them?

We often have people come in that need a bag of food (prescription) who are not clients. Is it legal for me to sell them food when I have never seen their pet?

A: The term prescription diet food is actually a misnomer in many ways. While the term is used frequently in the veterinary trade and pet care industries, diet foods generally do not require a doctor to have a veterinarian-client-patient relationship to sell the food to a customer.

The question to ask is whether or not the food product contains a legend drug or controlled substance in the product, which would require the veterinarian to have a veterinarian-client-patient relationship to dispense the drugs. If it does not, then the product can be sold without a veterinarian-client-patient relationship and without a prescription.

Please understand though this answer is from a legal stand point regarding regulation of veterinarians and prescription drugs and does not cover any type of contractual relationship between the products’ distributor and the veterinarian. We know that many makers of diet food (therapeutic diets) require that only veterinarians sell the food and only to their clients pursuant to a prescription.

In addition, remember that if the food is dispensed for the purposes of treating a medical condition, then the person making the diagnosis or other health determination of the animal would need to be a veterinarian.

Otherwise, simply allowing a person to come in to purchase food off your shelves because they say they want it does not require a veterinary-patient relationship unless the food contains a legend drug or controlled substance.

END NOTE:

The ultimate responsibility in the practice of veterinary medicine lies with the licensed veterinarian.

Professional discretion must always be exercised.

@FLORIDAVMA |

FLORIDA-VETERINARY-MEDICAL-ASSOCIATION | 27

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oss in 2015,

Central Florida. Solo doctor, small animal practice. $923K+ gross in 2015, 33% non-doctor. No Emergencies. (FL13M)

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facility on L42J)

Jacksonville. Solo doctor pr actice, well equipped leased facility on Monument Road. 4.5 day work week. Personal income of $172K. (FL42J)

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Central Florida. Solo doctor, small animal practice. $923K+ gross in 2015, 33% non-doctor. No Emergencies. (FL13M)

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Orange County. 2 doctor, small animal pr actice. $1.3M+ gross in 2015. No Emergencies. $359K personal income. (FL17O)

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Sarasota County. 4000+SF facility on approximately 1 acre cor ner lot near up and coming new neighborhood. 2 doctor, small animal practice. $1.1M+ gross. No Emergencies. (FL22E) HELPING PRACTICES THRIVE Pasco County. Rapidly gr owing area. $995K+ gross. No Emergencies, grooming or boarding. Leased facility. (FL10N)

or email Gavis to learn 1610call Frederica RoadDan * Saint Simons Island,more GA 31522 Toll Free: 800.333.1984 * www.simmonsinc.com 617.901.0044 / dgavis@vetcor.com Email: southeast@simmonsinc.com www.vetcor.com Licensed Florida Real Estate Broker THE FVMA |

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Orange Park Bedroom Community. Motivated seller ! Solo doctor, small animal practice located on Highway 17. Personal income to new owner projected at $178K. (FL12G)

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New– Duval Co.– Solo Dr. 2015 gross $545K, 3800 sq. ft. free standing hospital, digital x-ray, in house lab, 3 exam rooms.

North Florida– Solo Dr. small animal, 2015 gross $831k, Well established, well equipped, well staffed. Prx. & RE. owner motivated...priced to sell.

Sold-West Coast– 24 hr. E-clinic & Specialty Prx. 2015 gross $2.5mm MRI, CT, Hyperbaric chamber, and more.

North Central Fl.– Solo Dr. small animal, $360k gross with only 27 hour week. Great 1st practice for young Dr. or Dr. that just wants to work part time.

Equine Practice-Central Fl.—Solo Dr. Equine Practice. Office, 2 trucks, well equipped, experienced staff, 2015 gross $450K. New-N.E. Florida– Solo Dr. Prx + RE, grossed $503k in 2015.

Only 7 miles from the beach on the outskirts of a rapidly growing beach community. 2400 sq. ft. office w/2 exam rooms.

Brevard County: Great location! Owner entertaining all offers. Profitable, +1,800sf SA w/2-exam rooms.

Leasehold. FL83 Indian River County: Feline! +1,765sf beautiful leasehold facility on busy highway. Well-organized, Turn-key – Must See! FL84 Pinellas County: Double-Digit Growth! +1,500sf lease hold in high traffic area. Recent renovations!

3-exam rooms. FL74 Pinellas County: Feline! +2,400sf w/RE, prime location.

2-exam rooms & rental income. Gross income +$620K w/Est. ADI+$167K. FL86 Sarasota County - Holistic & Conventional Medicine! +1,350sf leased facility w/2-exam rooms.

4-day work week! Strong Growth. FL87 Visit psbroker.com to see our full list of practices, or call our experienced staff for a free and confidential conversation to help you find the right practice in the right location.

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FLORIDA-VETERINARY-MEDICAL-ASSOCIATION | 29

CLASSIFIED ADVERTISEMENTS RELIEF VETERINARIANS

RSVP (RELIEF SERVICES FOR VETERINARY PRACTITIONERS) : is seeking veterinarians for full time, part time and sporadic relief work in the state of Florida. Moonlighters are welcome! Choose when and where you work, for premium pay! For more information or to apply, please visit www.reliefvet.com or call 800-256-4078.

(Exp. Issue 5 & 6/15, 1-4/16; ID #3041)

EXPERIENCED SMALL ANIMAL VETERINARIAN AVAILABLE: St. Lucie, Okeechobee, Indian River and Martin counties. R. A. Swiezy, DVM – (772) 418-1939 (Exp. Issue 4, 5 & 6/16; ID #26336) FULL TIME ASSOCIATE OR RELIEF VETERINARIAN NEEDED at a busy Veterinary Hospital in Lakeland, Florida. We are well equipped with in house labs, ultrasound, digital x-ray, surgical and therapeutic lasers. We are fully staffed with friendly and dedicated employees.

Please, communicate by asking for Rhonda, using the office phone 863-859-9485. Or email irelanvet@gmail.com. or 863-398-6182 cell phone. (Exp. Issue 4, 5 & 6/16; ID #28422)

ASSOCIATES WANTED

EMERGENCY VETERINARIAN NEEDED for well established emergency clinic (32 yrs.) located 20 minutes from I-4 and 40 minutes from either Tampa or Orlando at Parkway Veterinary Medical & Surgical Center. Interested candidates please contact Dr. Dorsey Hightower at (863) 398-4758. (Exp. Issue 4/16; ID #28211) EMERGENCY VETERINARIAN WANTED FOR STATE-OF-THE-ART MULTI-SPECIALTY & EMERGENCY HOSPITAL located on the SW coast between Ft. Myers and Naples. Our specialties include Internal Medicine, Surgery, Neurology, and Cardiology. Our specialists and emergency clinicians meet twice daily for comprehensive patient rounds and specialists are available to ER after hours. A competitive compensation and benefits package is available for the right individual.

Interested candidates please contact Dr. Wendy Arsenault at 239-992-8387 or warsenault@swfvs.com. Visit us on the web at www.SWFVS.com. (Exp. Issue 3 & 4/16; ID #1365)

EXPERIENCED VETERINARIAN NEEDED: Animal Health Care Clinic, located in Clearwater, FL is only two miles from the beautiful white beaches Florida is known for with nearby restaurants, shopping, Clearwater Aquarium, and all major airports. Our skilled and supportive staff is excited to add a new experienced veterinarian to our team. We are a fast-paced hospital and see a lot of emergency care visits allowing our doctors to work up many interesting cases.

We see a high volume of surgical cases so an interest in surgery would be ideal. We reward our veterinarians with a generous compensation package including a competitive salary, medical, dental, and liability insurance, as well as CE, PTO and more. Please contact Tory Johnson at tjohnson@vetcor.com (Exp. Issue 4/16; ID #26703) FULL/PART-TIME VETERINARIAN – PACE, FLORIDA: Ark Animal Hospital is an AAHA accredited hospital on the Florida Panhandle. We are a small animal practice with seven doctors and a well trained support staff. We are looking to continue our reputation as a high quality, caring hospital, by adding another great doctor to our team. Salary negotiable.

Requirements : Current DVM Florida license. Two or more years experience. Send resume to : Arkanimalhospita@bellsouth.net attn: Sandie (Exp. Issue 4/16; ID #18446) VETERINARIAN NEEDED FT OR PT: Fox and Friends Animal Hospital in Sun City Center Fl. is seeking a veterinarian. We are located in Hillsborough County approximately 30 minutes south of Tampa near the Tampa Bay beaches, fishing, golfing, etc. A newly built free standing building 6 years old. Hours of operations are Monday to Friday 8am5pm, Saturday 8am-12pm. Please call 813-633-2443, fax 813-633-8084 or email foxandfriendsah@gmail.com (attention Dr. Steven Fox, Anne or Amanda) (Exp. Issue 4 & 5/16; ID #11141)

30 | FVMA ADVOCATE

GREAT OPPORTUNITY FOR HALF-TIME OR FULL-TIME VET IN GAINESVILLE! Oaks Veterinary and Northwood Oaks Veterinary Hospitals are looking for an experienced half-time or full-time veterinarian to join our bustling and growing practice. We are located in beautiful Gainesville, FL home of the University of Florida. The area has world class dining, 4 play houses, museums, and natural springs offering various recreation such as canoeing, kayaking tubing and more. If you want work in a great environment where you will build your professional skills while enjoying a great quality of life, this is the place for you! We welcome all experienced veterinarians with a passion for providing comprehensive, compassionate and caring veterinary medicine to apply.

Please contact Dr. Kaplan-Stein at dkaplanstein@vetcor.com (Exp. Issue 4/16; ID #28716) EASTSIDE ANIMAL CLINIC OF NAPLES, FL is currently looking to add an associate DVM to its two doctor practice. The clinic is housed in a modern, two story, 7200 sq. ft. free-standing building and is equipped with a new IDEXX lab, CO2 surgical laser, K-laser, and digital dental x-ray. The practice is well-managed, employs several certified technicians, and was just voted the 2016 SW Florida Choice Award for Best Veterinarian. We would like to add ultrasound, so preference will be given to applicants with experience or interest in that area. Hours will be full-time, include Saturdays, but no emergency duty. Salary and benefits dependent upon experience. Please send resumes to: D. Keith Johnson, DVM or Stacey Cox, CVT/OM at 4493 Tamiami Trail East, Naples, FL 34112; or email to eastsideanimalclinic@comcast.net. (Exp. Issue 4/16; ID #28551)

ASSOCIATE VETERINARIAN NEEDED FULL/PART TIME FOR A SMALL ANIMAL HOSPITAL LOCATED IN CHARLOTTE COUNTY, experience preferred. Wages are based on a percentage of gross with guaranteed minimum salary. We are looking for a veterinarian who is practicing high quality medicine, a skilled surgeon and cares for his/ hers patients. Quality and compassionate care is important for our practice. We have a great practice with a great team and look forward to finding a new team member. Send resumes via fax to 941-473-9193 or email to sunnybrookanimalhospital@gmail.com. You may also mail them to Sunnybrook Animal Hospital Attn: Dawn or Sherri 4089 South Access Rd Englewood, FL 34224 or call 941-474-6393.

(Exp. Issue 4/16; ID #27392) CALLING ALL VETERINARIANS! YOUNG'S ANIMAL HOSPITAL IS LOOKING TO FILL A UNIQUE OPPORTUNITY FOR AN ASSOCIATE VETERINARIAN TO JOIN OUR ENERGETIC AND GOAL ORIENTATED TEAM. Young's Animal Hospital is a thriving and progressive four-doctor small animal/exotic practice located in Titusville, Florida. We operate in a 10,000 square foot, state of the art facility, and the practice was established in the 1970's. Our staff includes Certified Veterinary Technicians along with many experienced, long term staff members.

We practice an excellent caliber of medicine, treating our patients as family. We have top-notch equipment including an Ultrasound, CO2 laser, Class IV Therapeutic Laser, Digital Dental X-ray and Digital X-Ray. We are also affiliated with a Board Certified Orthopedic surgeon who performs operations on site.

Titusville is located on the Space Coast and is a great place to be outside under the sunshine enjoying the beach, fishing, boating, golfing or kayaking. Titusville is next door to Kennedy Space Center, Merritt Island National Wildlife Refuge, Canaveral National Seashore and Port Canaveral. We are also within driving distance of Orlando and the theme parks like Walt Disney World and Universal Studios. We are a short drive away from Daytona Beach and Daytona International Speedway.

If you would like to be part of a winning team that upholds a high measure of care, you might be the right fit for this position! Young's Animal Hospitals offers a competitive income with a compensation

package that includes medical, dental, vision, 401K participation, life insurance & CE/licensing allowance.Requirements: 1.DVM; Board certification/state license. 2. Demonstrated conflict resolution skills.

Qualified candidates should submit a short cover letter expressing their interest to Becky New, Hospital Administrator, at bnew@cfl.rr.com.

Young's Animal Hospital - Providing exceptional, state-of-the-art medicine, working as a team, in a compassionate, caring environment.

(Exp. Issue 4/16; ID #899)

SMALL ANIMAL HOSPITAL LOOKING FOR FT ASSOCIATE: The Old 41 Animal Hospital in Bonita Springs Florida is looking for a full time associate. The hospital is located 3 mile from the beach in an affluent area adjacent to Naples Florida on the gulf coast.

The hours would be 9 to 6 Monday through Friday with 2 hours for lunch. No after hours emergencies or weekends. The opportunity for buy in is available. Good people skills are a must. Salary commensurate with experience. Digital radiology, digital dental equipment in house lab is present, opportunity for exotics is available. Send copy of a resume to scottgregorydvm@aol.com or fax to 239-676-9938 (Exp. Issue 4/16; ID #1507)

ASSOCIATE VETERINARIAN WANTED – FULL TIME – SMALL ANIMAL: Coastal Animal Medical Center in affluent Lakewood Ranch, Florida is hiring full-time associate veterinarian for progressive, growing practice. Experienced doctors and new graduates are welcome to apply.

Compensation consists of a base salary, production bonus and benefits, and is dependent on experience. Contact Rene rene@coastalamc.com or (941) 747-7107. (Exp. Issue 4/16; ID #7939) NON-PROFIT CLINIC SEEKS PT ASSOCIATE VET - PENSACOLA, FL

Pensacola Humane Society seeks veterinarian for Friday and Saturday wellness and minor illness/injury clinic. Candidate must be comfortable being sole vet onsite with support staff. Some in-house testing available. Enjoy freedom to provide care to pets in need despite owner's ability to pay. Must have FL license. Competitive pay. E-mail director@pensacolahumane.org (Exp. Issue 4/16; ID #34850)

PRACTICE FOR SALE OR LEASE

SMALL ANIMAL PRACTICE FOR SALE OR LEASE – JACKSONVILLE, FL.: Thirty five year old small animal practice at the five point intersection of Normandy Blvd., Jacksonville, Florida. 7500 square foot building, two story, facing two streets, vacant site.

Owner is retiring. Call Dr. Devegowda Gopal, (904) 786-4919.

(Exp. Issue 4 & 5/16; 888)

EQUIPMENT FOR SALE

PRACTICE LIQUIDATION FLORIDA, ITEMS IN EXCELLENT CONDITION, PRICES NEGOTIABLE Shorline Hydraulic, Thermal, V-top Surgical table $1800 Flogard 8000 Volumetric Infusion Pump (2 available) $350.00 Welch Allyn 767 Series Wall Transformer, otoscope and ophthalmoscope heads (3 available) $295.00 each Accuscope Microscope $225.00 Summit LX125V X-ray Collimator $1550.00 Instrument Table $75.00 Stainless Surgical Tilt Table $750.00 Stainless Surgical Side Tables (2 available) $150.00 each Shorline Kennels Model 902.0105.42 Option C (2 available) $1750.00 each Pictures and Measurements Available Upon Request

Please Call: (727) 817-0606 OR Email: thegentlevet@yahoo.com

(Exp. Issue 4/16; ID #4131 )

Practice Sales | Valuations Associate Buy-Ins | Buyer Representation

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FLORIDA-VETERINARY-MEDICAL-ASSOCIATION | 31

Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809

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We Have Sold More Veterinary Practices Than Anyone.