FVMA Advocate Issue 3, 2023

Services Include:

• Abdominal Ultrasounds

• Echocardiograms

• Pregnancy Checks

• FNA Biopsy Guidance

Benefits to your clients

• Increases potential for early intervention

• Maintains primary doctor relationship

• Eliminates client travel to specialist

• Diminishes client’s stress & anxiety

7207 Monetary Drive

Orlando, Florida 32809

Phone: 407-851-3862

800-992-3862

Fax: 407-240-3710

info@fvma.org

www.fvma.org

BOARD OF GOVERNORS

DR. JACQUELINE S. SHELLOW

President

DR. SCOTT RICHARDSON

President-elect

DR. ALEX 'STEVE' STEVERSON

Treasurer

DR. MARTA P. LISTA

Immediate Past President

DR. ERNEST C. GODFREY

Trustee Emeritus

JIM NAUGLE

Executive Director

BOARD OFFICERS

DR. RICHARD B. WILLIAMS

AVMA Delegate

DR. RICHARD C. SUTLIFF

AVMA Alternate Delegate

DR. BROOKE EUBANKS

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. BETH KESER

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. SALLY DENOTTA

FAEP Representative to the FVMA Executive Board

President's MESSAGE

Greetings,

I hope everyone is enjoying their summer. Some of us, including your Executive Director, Jim Naugle, and your AVMA Delegates, represented the FVMA at the recent AVMA Convention 2023 in Denver. Our AVMA Delegates have been busy with the Legislative Advocacy Committee working on our telemedicine bill, collaborating with the Florida Veterinary Technicians Association (FVTA), and preparing for the next legislative session. Please consider supporting the FVMA PAC, so we can continue to look out for the best interests of veterinarians in Florida.

We have two great continuing education meetings this fall, and both meetings will offer the three-hour Florida Laws and Rules & Dispensing of Legend Drugs course needed for license renewal next year.

The Gulf Atlantic Veterinary Conference (TGAVC) will be in Tampa September 14-17, and the FAEP Promoting Excellence Symposium (PES) will be in West Palm Beach October 19-22. Check out our website for program details, speaker lineup, and wet lab options.

The FVMA was recognized for their service and dedication in protecting Florida’s animal sector before, during, and after Hurricane Ian by Florida’s State Agricultural Response Team (FLSART) at their planning workshop last month in Daytona Beach. I want to give a special thanks to Jim Naugle and his staff, and to Dr. Terry Clekis, the chair of the FVMA’s Disaster Preparedness Committee, for their hard work and dedication. As hurricane season is here once again, please take some time to make plans to be as prepared as you can for yourself and your families, animals, and clinics.

Please note, the former District 1 Representative stepped down from her position in May 2023. Dr. Brooke Eubanks has assumed the role until the next general election in April 2024.

We would like you to become more involved in the FVMA and/or the FAEP. Please get to know your district representative. We are here for you! How can we help?

Warm Regards,

Jackie Shellow, DVM, MS

JIM NAUGLE Executive Director

ERIKA MEYER

Administrative Manager

NICOLE ALVAREZ

Marketing & Communications Manager

JESSICA KEATTING

Graphic Designer

KATHERINE PEARCE

Senior Creative Lead

JILLIAN SINCLAIR

Marketing Specialist

SOFIA GONZALEZ

Jr. Graphic Designer

CYNDI WHITAKER

Director of Conferences & Strategic Partnerships

RALPH HUBER

Business Development Manager

JASON SMITH

External Relations Manager

DAMON PATAI

Meetings & Events Planner

MELISSA MEDAL

Senior Meetings & Events Planner

PAIGE VOGT

Membership & Engagement Manager

LIAM CROSS

Database Specialist

MARIBEL BLUM

Finance & Accounting Manager

YOU ARE THE CENTER OF OUR FOCUS.

We focus on you so you can focus on them.

A lot of tasks compete for your time as you manage your practice. From administrative work and equipment maintenance to client communications, appointment scheduling and reminder phone calls, it’s easy to lose sight of what’s most important. Patterson’s experienced support teams help you take care of these details so you can get back to what you love – helping your patients.

TRUSTED EXPERTISE. UNRIVALED SUPPORT.™

MEMBER SPOTLIGHT: Dr. Elizabeth Chosa

Dr. Elizabeth Chosa was born and raised in Johnson City, TN, and decided to be a veterinarian at age three. She earned her undergraduate degree from the University of Virginia and her DVM from the University of Georgia. She then served on active duty in the U.S. Army Veterinary Corps for five years. Her first duty station was Fort Meade, MD, where she cared for working dogs in the military and federal agencies including the National Security Agency and Secret Service. She then cared for dolphins and sea lions with the Navy Marine Mammal Program before being honorably discharged in 2010.

Dr. Chosa moved to Brevard County, FL, and worked as an associate veterinarian before purchasing Courtenay Animal Hospital in March 2012. After 10 years of hospital ownership, Dr. Chosa sold her practice in 2022 to become a full-time mom and part-time veterinarian. She works as a relief veterinarian for GP and ER practices in both Florida and Michigan and provides mentorship in the veterinary community through DVMoms, a support group for veterinarians who are mothers.

After the veterinary community lost multiple colleagues to suicide in quick succession, she cofounded the Veterinary Hope Foundation (VHF) with Dr. Blair McConnel in 2021, a 501(c) (3) organization which offers free support groups for the animal care community and focuses on education and connection to help protect the mental health of veterinarians and support staff.

“After researching existing programs, we realized that most available resources were directed toward veterinarians in crisis,” Dr. Chosa says of the founding. “We wondered if there might be a way to support veterinarians before they reached a crisis state. As veterinarians, we know how important preventive care is for physical health, and we started contemplating what preventive care might look like for mental health. We formed a small board of concerned veterinarians and partnered with mental health professionals who had experience working with animal care teams. We conducted market research with our colleagues, first informally and later formally, to determine what resources were needed most.”

Through the focus groups, they learned the majority of veterinarians are struggling with the same challenges, and that many of them feel isolated and are longing for community. These veterinarians are often introverts who are emotionally exhausted from their jobs and do not have the time and energy to form strong personal connections.

“We knew that by offering support groups led by mental health professionals we could achieve two goals: provide educational resources to help address common challenges while also building relationships and lasting community. We hosted our first three pilot groups in the fall of 2021, and many of those participants are still in touch! They have continued to provide support to one another in all aspects of life, long after the formal sessions ended.”

Katherine Pearce | Senior Creative Lead Florida Veterinary Medical Association

Dr. Chosa says that the value of these relationships is difficult to measure quantitatively, but having someone who really understands and supports you makes a huge difference in quality of life. Isolation is a known risk factor for mental health crises, so staying engaged and connected to others can be protective for mental health. VHF has been able to help more than 100 veterinarians and offers support groups for all members of the animal care team. They have 10 licensed mental health professionals, with extensive experience in the animal care community, serving as facilitators. These facilitators also complete specialized training through VHF to lead these groups. Currently, VFH offers three groups per month, but thanks to industry sponsors, they are poised to offer more.

Each support group meets once a week for six weeks with sessions lasting 60-75 minutes. These online meetings are held after hours to make them as accessible as possible for participants. The needs of the individual group members guide the meetings, but each week has a different topic of discussion with a curriculum based on market research. VHF has held specialized groups for veterinarians working in certain sectors of the profession and in specific roles within hospitals, but all groups discuss topics such as healthy boundaries, conflict resolution, self-compassion, imposter syndrome, and work/life integration.

As a practice owner, Dr. Chosa’s focus was ensuring that all her patients received the highest possible level of medical care in a nurturing environment, emphasizing preventive care and maintaining wellness as the best way to keep patients healthy and happy.  As a founder of VHF, her goals for veterinary professionals are the same – ensuring that veterinarians and their staff members have access to preventive care for their mental health in a caring community that helps maintain their wellness. VHF continues to grow and is ready to reach more veterinarians and staff to make a larger positive impact on the profession as a whole.

“I still love my work as a clinician, but I also feel an obligation to give back to this amazing profession that has given me so much,” Dr. Chosa says. “The VHF is the best way I know how to bring light into a profession that sometimes feels dark. I firmly believe that if we can build community and encourage veterinary professionals to take care of themselves and each other with the same compassion they’ve always had for their patients, we can make a lasting difference.”

To learn more about VHF, visit www.veterinaryhope.org

A COMMUNITY of support IS WAITING!

Guided discussions with rotating topics of conversation carefully chosen to reflect the needs of practitioners.

A place to share thoughts and perspectives and hear the thoughts and perspectives of others.

A close community of acceptance, respect, and support of one another’s individuality and concerns.

From the beginning, we said that if we could help even one veterinarian feel less alone in the world, it would be worth it.

- DR. ELIZABETH CHOSA

NUTRITION FOR THE Hospitalized Veterinary Patient

Ed Carlson | CVT, VTS (Nutrition) VetBloom

Image courtesy of Canva.

INTRODUCTION

Nutrition is vitally important to the hospitalized patient. Unfortunately, the nutritional needs of hospitalized patients are often overlooked. Doctors’ orders might not include specific feeding instructions. Patients may be unwilling or unable to eat or may not be consuming adequate calories to meet their energy requirements. Whatever the reason, as patient advocates, veterinary nurses should take a proactive role to ensure that the patients’ nutritional needs are met.

Medical intervention to stabilize the critically ill patient before initiating nutritional support, including dehydration and acidbase and electrolyte imbalances, is important to reduce the risk of possible additional complications. Patients in a state of shock, for example, may have reduced perfusion to the gastrointestinal tract, leading to reduced gastrointestinal motility, nutrient absorption, and digestion.

WHY IS NUTRITION SO IMPORTANT FOR THE HOSPITALIZED PATIENT?

Daily nutrients in controlled amounts are crucial to maintaining optimal immune function, normal cellular structure, and assist with drug metabolism. Patients not consuming adequate nutrition are prone to lean body mass loss, delayed wound healing, weakness, and organ dysfunction. These patients may also have an increase in acquired infections and bacterial translocation. Bacterial translocation is defined as the passage of viable bacteria from the intestines to extraintestinal sites, such as the mesenteric lymph node complex, liver, spleen, kidney, and bloodstream.

Research has shown that the addition of glutamine, arginine, and omega-3 fatty acids can augment intestinal barrier function and prevent bacterial translocation. Multiple studies have shown that providing early enteral nutritional support can shorten hospital stays.

DIETARY CONSIDERATIONS

Healthy dogs and cats use and store energy derived from protein, fat, and carbohydrates very effectively. However, in an unhealthy state, reduced gastrointestinal absorptive and digestive enzyme production, as well as insulin resistance, may affect dietary carbohydrate tolerance. This may result in altered glucose control and/or diarrhea. Diets formulated for recovery are more often calorically dense and have lower carbohydrate content.

It is important to provide critical patients with adequate dietary protein that supplies essential amino acids. High dietary protein may be used in place of carbohydrates in critical feline and

canine patients who are not able to handle carbohydrates well. High protein may be contraindicated in patients with renal disease and those with comorbidities, such as hepatic disease and encephalopathy with pancreatitis.

Calories provided from fat are equally important in the critical patient. Fat is more calorically dense than protein or carbohydrates; therefore, patients may ingest a smaller volume of food while still consuming more calories. High-fat content is contraindicated in patients with pancreatitis.

Arginine, an amino acid, is essential to protein synthesis and has an immuno-preserving effect on protein malnutrition. Glutamine, also an amino acid, plays a role in protein metabolism, nutrient absorption, and intestinal immune function. Folic acid, thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, and vitamin B12 are required for the metabolism of protein, fat, carbohydrates, and glucose. Patients consuming their resting energy requirement (RER) of a commercial diet should be receiving an adequate amount of these vitamins. However, patients that are not eating should be supplemented with vitamin B complex in crystalloid intravenous fluids or with parenteral nutrition containing vitamin B complex.

FEEDING RECOMMENDATIONS

Enteral feeding is preferred in patients who can tolerate it. Feeding tubes should be considered in patients that are unwilling or unable to eat. Nasogastric feeding tubes are easily placed without anesthesia and are often a good option in critical patients; they allow for trickle feeding or bolus feedings of a liquid diet. Esophagostomy tubes and percutaneous-guided gastrostomy tubes should be considered for patients requiring long-term assisted nutritional support once stable enough for general anesthesia. Force-feeding patients by mouth may cause food aversion and should be avoided.

Obtaining a nutritional history, including how long the patient has been anorexic at home before being admitted to the veterinary hospital, is crucial in critical patients. Feeding tube placement to provide nutritional support for feline and canine patients that have been anorexic for three or more days should be considered. Parenteral nutrition should be considered in patients that are unable to tolerate feeding by mouth, such as patients with uncontrolled vomiting.

ENERGY REQUIREMENTS

The RER is the energy requirement for a normal animal, which is not fasted and is at rest under thermo-neutral conditions, such as hospitalized patients. There are several equations are used to calculate RER:

RER = 70 × (body weight in kg)¾ or

RER = √√ × (weight in kg × weight in kg × weight in kg) = × 70

Alternatively, for animals weighing between 3 kg and 25 kg, the following calculation should be used:

RER = (30 × current body weight in kg) + 70

The general recommendation to begin enteral feeding of anorexic patients is one-third of the patient’s total RER for the first 12 to 24 hours and, if well tolerated, to gradually increase this amount every 12 hours until full RER is reached. If at any time the patient vomits, discontinue feeding until vomiting has resolved, reduce the volume when feeding is resumed, and increase the volume more slowly. In the past, an illness factor was often added to the RER when feeding hospitalized patients. However, this practice is no longer recommended because excessive nutrition during times of illness may increase the risk for hyperglycemia and other metabolic complications.

NASOGASTRIC AND NASOESOPHAGEAL TUBE FEEDING

Only liquid veterinary diets should be used for feeding through nasogastric and nasoesophageal tubes because of the small diameter of these tubes. Trickle feeding via constant rate infusion is most often used for hospitalized patients, although these tubes may also be used for bolus feedings and to administer oral liquid medications.

Many liquid diets designed for humans are also available; these diets are typically less expensive than veterinary liquid diets. However, they are nutritionally inadequate for long-term use. These human diets are especially inappropriate for cats because they are too low in protein, taurine, and arginine.

PARENTERAL NUTRITION

Parenteral nutrition (PN) is a nutritionally balanced solution that provides calories and nutrients to patients that cannot tolerate enteral nutrition or should not be fed by mouth. PN provides caloric, protein, and micronutrient requirements and should be administered only via a central venous catheter because of its high osmolality. Partial PN provides only part of a patient’s caloric, protein, and nutrient requirements. However, it has a lower osmolality and therefore may be administered via peripheral intravenous catheters. Complications associated with PN include hyperglycemia, hyperlipidemia, the potential risk for infection, intestinal atrophy (with subsequent risk for bacterial translocation), increased rate of sepsis, and azotemia. Aseptic technique is required, and extreme care should be taken with the handling and administration of PN. If contaminated,

PN can become an excellent growth medium for bacteria. A study by Jensen and Chan showed that patients receiving PN that were also trickle-fed had a higher survival rate than those receiving PN only. If PN is used, the general recommendation is to begin trickle feeding as soon as the patient will tolerate it and gradually increase enteral feeding.

NURSING CARE

An important role of the veterinary nurse is to closely monitor hospitalized patients. Identifying potential problems and alerting the veterinarian allows for the patient treatment plan to be adjusted, potentially improving patient outcome. In addition to the standard monitoring of vital signs, vomiting, and diarrhea, hospitalized patients should be monitored for signs of refeeding syndrome, food aversions, fluid overload, electrolyte imbalances, feeding tube malfunction, and infection of feeding tube insertion sites.

Experienced veterinary technicians and veterinary nurses generally use a variety of coaxing techniques to encourage their patients to eat. Warming canned food, for example, may work for some patients, while chilled canned food may be better accepted by nauseous patients. Hand feeding, petting, and talking to the patient in a soothing manner during feeding time may work with some patients, while others may prefer to eat when left alone and undisturbed.

Good record-keeping is essential to determine whether the patient is consuming adequate calories or whether assisted feeding should be initiated, continued, or discontinued. Nursing notes should include the specific food offered, the volume of food offered, the approximate volume of food consumed, and calories consumed.

Veterinary nurses should also understand diet options recommended for various diseases and work closely with veterinarians to provide hospitalized patients with the best nutrition options.

CONCLUSION

The goal of feeding the critical patient is to prevent or minimize malnutrition, prevent nutrient deficiencies, and provide nutrients to promote healing. Veterinary nurses and the entire veterinary health care team play an essential role in providing nutritional support that may improve patient outcomes.

REFERENCES

• Chan DL, Freeman LM. Nutrition in critical illness. Vet Clin Small Anim 2006;36(6):1225- 1241.

• Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ. Small Animal Clinical Nutrition, 5th ed.Topeka, KS: Mark Morris Institute; 2010.

• Brunetto MA, Gomes MO, Andre MR, et al. Effects of nutritional support on hospital outcome in dogs and cats. J Vet Emerg Crit Care 2010;20(2):224-231.

• Krentz T, Allen S. Bacterial translocation in critical illness. J Small Anim Pract

• 2017;58(4):191-198.

• Berg RD. Bacterial translocation from the gastrointestinal tract. J Med 1992;23(3-4):217- 244.

• Campbell JA, Jutkowitz LA, Santoro KA. Continuous versus intermittent delivery of nutrition via nasoenteric feeding tubes in hospitalized canine and feline patients. J Vet Emerg Crit Care (San Antonio) 2010;20(2):232-236.

• Liu DT, Brown DC, Silverstein DC. Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis: a retrospective study of 45 cases. J Vet Emerg Crit Care (San Antonio) 2012;22(4):453-459.

• Mohr AJ, Leisewitz AL, Jacobson LS, et al. Effect of early

enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis. J Vet Intern Med 2003;17(6):791-798.

• Case LP, Daristotle L, Hayek MG, Foess M. Canine and Feline Nutrition: A Resource for Companion Animal Professionals. Maryland Heights, MO: Mosby-Elsevier; 2011.

• Jensen KB, Chan DL. Nutritional management of acute pancreatitis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2014;24(3):240-250.

ED CARLSON CVT, VTS (Nutrition)

Ed Carlson is the director of veterinary nursing education for VetBloom. He is the treasurer of the New Hampshire Veterinary Technician Association and the Secretary of the Massachusetts Veterinary Technician Association. Ed has served on multiple National Association of Veterinary Technicians in America (NAVTA) committees and was the 2021 NAVTA President. He obtained a VTS (Nutrition) in 2014 and lectures frequently at local, regional, national, and international veterinary conferences on a variety of topics. Ed also received the NAVTA Technician of the Year award in 2019.

Florida Practices for Sale

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FL, New Listing! Florida Panhandle, 1 DVM, SA practice, est 30 years, $1.1M & growing, 0.8 mile to emerald water beach. PRX & RE (FL32P)

PRICE REDUCED! FL, Titusville, East Coast: Open 5 days a week, Solo Dr, 2940SF free-standing facility located on .60 acre, 3 exam rooms, Abaxis in-house blood machines, TTM Revenues of $1.4M, buyer’s after debt income $260K+. PRX/$225K + RE/$500K (FL40T)

FL, Palm Beach County: Solo, DVM, $1.6M+ Gross, 5 -day work week, no weekends, 2142SF free-standing facility, loaded with equipment, seller willing to stay employed if needed. PRX & RE (FL53L)

For listings nationwide, add yourself to Practice Watch from our website. 800.333.1984 | southeast@simmonsinc.com | simmonsinc.com

Simmons Says: Considering a Corporate Sale?

Minimum expectations of consolidators:

• 2 FT contracted DVMs

• $1.2M gross revenues

• $250K EBITDA

• Producing seller remaining a minimum of one year post sale

To maximize your practice sale price and terms, work with Simmons & Associates!

FLUORESCENCE

Annette Lundberg | DVM

Amelia White | DVM, MS, DACVD

Auburn University College of Veterinary Medicine

Image courtesy of Adobe Stock.

Photobiomodulation is the use of visible to near-infrared light waves to create therapeutic changes in the skin. Fluorescence photobiomodulation is a subset of this and has been used to treat cutaneous infections, inflammatory conditions, and wounds. It has a favorable safety profile and offers another option in the treatment of dermatologic diseases in veterinary species.

PHOTOBIOMODULATION AND FLUORESCENCE

Photobiomodulation

Photobiomodulation uses the interaction of visible (400-750 nm) to near-infrared light waves with endogenous cellular chromophores such as water, melanin, porphyrin, flavins, and cytochrome C oxidase to create a desired effect (e.g. reduction of inflammatory mediators, activation of fibroblasts and keratinocytes, decreased bacterial adhesion to keratinocytes, bacterial killing, etc.). The wavelength, intensity, and duration of illumination influence the effects of light on tissue.

Blue light (400-495 nm) has the shallowest penetration into the skin, reaching the epidermis and superficial dermis. Blue light primarily has been studied for its antimicrobial effect. The antimicrobial effect is thought to be due to blue light triggering the production of reactive oxygen species within the bacterial cells resulting in cell death. Blue light phototherapy has been shown to alter the structure of methicillin-resistant S. aureus (MRSA), which disrupts the cell membrane and decreases its ability to replicate. Human studies have found efficacy against fungal species such as Candida sp., Malassezia sp., and dermatophytes.

Green light (495- 570 nm) can penetrate the mid-dermis. It has been studied for its effects on wound healing, osteoblast differentiation, alteration of melanogenesis, and regulation of intracellular calcium. Yellow and orange light (570-600 nm) can stimulate collagen synthesis, improve wound healing, and reduce skin pathogens. Red light (600-750 nm) can reach the

deep dermis or hypodermis depending on the thickness of the skin. This set of wavelengths has been studied for its effects on wound healing and demonstrated to reduce inflammation, increase collagen synthesis, and induce proliferation of mesenchymal stem cells and epithelial cells. The primary proposed mechanism of the effects of red light on wound healing is the stimulation of adenosine triphosphate within the mitochondria.

Fluorescence photobiomodulation

Fluorescence photobiomodulation is a form of photobiomodulation in which the light emitted from the initial light source is altered by an exogenous chromophore. This creates longer wavelength photons and expands the therapeutic potential. The commercially available form of fluorescence photobiomodulation is called the Phovia™ System made by Vetoquinol. This system uses a topical photoconverting hydrogel

Severe superficial spreading pyoderma on a dog’s back suspected to be secondary to immunosuppression with glucocorticoids. The infection was treated with Phovia™ (two consecutive treatments once weekly) and topical silver sulfadiazine cream.

Image courtesy of Drs. Annette Lundberg and Amelia White.

Deep infection on a dog’s paw suspected to be caused by unknown trauma. The infection and wound were managed with Phovia™ (two consecutive treatments once weekly), cephalexin, and topical silver sulfadiazine cream.

Image courtesy of Drs. Annette Lundberg and Amelia White.

and a blue light-emitting diode (LED) lamp. The interaction of the light from the LED lamp and photoconverting hydrogel emits low-energy fluorescence within the 500-700 nm range. Fluorescence photobiomodulation has been studied in a number of conditions in dogs including superficial pyoderma, deep pyoderma, interdigital pyoderma, perianal sinuses, otitis externa, acute traumatic wounds, chronic wounds, and surgical wounds. It has also been used by the authors as an adjunct treatment in the management of feline eosinophilic granulomas, inflammation associated with allergies, and anal sac rupture. Additionally, the authors have implemented Phovia™ light therapy in the treatment of dermatological diseases in birds, small mammals, horses, and cats.

The primary proposed mechanism of fluorescence photobiomodulation in wound healing is the stimulation of adenosine triphosphate within the mitochondria. The blue-green wavelengths may also help regulate intracellular calcium. In a study on canine deep pyoderma, areas treated with fluorescence photobiomodulation showed less tissue inflammation when compared to systemic antibiotics alone. A similar finding was demonstrated in a study on canine surgical wounds. In both studies, this was evidenced on a molecular level with a decrease in the pro-inflammatory marker tumor necrosis factor-∝ and an increase in the anti-inflammatory markers such as epidermal growth factor and collagen III.

CLINICAL USE Application

The use of Phovia™ System is typically well tolerated by patients. In most cases, it can be performed without the need for sedation. However, in cases where the patient is in pain or does not allow contact with the affected area, sedation may be required. The photoconverting hydrogel comes in two parts: a jar of clear hydrogel and an ampule of orange photoconverter liquid. These two parts are combined prior to application. Once combined the photoconverting hydrogel is only stable for 24 hours at refrigeration and should be kept in a dark area.

If any debris or crusting is present on the lesion, the area should be gently cleaned prior to treatment to avoid any impedance to the ability of the light to reach the skin. The photoconverting hydrogel is then applied to the affected area such that it is approximately 2 mm thick. The LED lamp is positioned above the lesion as close to the skin as possible without touching it. Once the “on” button on the LED lamp is pressed, the light turns on for two minutes. Following the two minutes, the LED lamp will automatically turn off. The hydrogel should be removed from the skin using gauze soaked in sterile saline. As blue light is emitted by the LED lamp, the users should wear appropriate blue-light filtering protective goggles and the patient’s head should be facing away or their eyes covered while illumination occurs.

The manufacturer recommends that the treatment be performed twice per week. This can either occur as a single treatment once every three to four days. Alternatively, the treatments can be performed consecutively with a one-minute resting period. When using consecutive treatments, the hydrogel should be removed and reapplied between illuminations. The treatment has a favorable safety profile; however, topical reactions occur rarely.

Role in Treating Skin Infections

Antibiotic resistance is a growing concern in both human and veterinary medicine. It represents the largest health concern worldwide. Due to this, there is an increasing need for effective alternatives to systemic antibiotics. Topical antimicrobial therapy treatments are excellent alternatives in the case of surface or superficial skin infections with bacteria or yeast. These reach high concentrations on the skin with few systemic side effects and are available in many formulations including shampoos, conditioners, mousses, and wipes. However, the application of topical antimicrobial therapies can result in complex treatment plans and high caretaker burden. Additionally, topical therapy is not typically effective for deep skin infections. Therefore, therapy which decreases owner burden but still limits the use of systemic antibiotics is crucial.

Full thickness wound with cartilage exposure on a dog’s ear secondary to debulking of proliferative otitis externa using a surgical laser. The wound was managed with Phovia™ and topical silver sulfadiazine cream. Image courtesy of Drs. Annette Lundberg and Amelia White.

Fluorescence photobiomodulation is an example of this. For many clients, bringing their pet to the veterinary office once to twice weekly may be more convenient than administering oral medication or applying topical medications once to twice daily. An appointment for two consecutive treatments typically takes 15 minutes and can be performed as a technician appointment. It is important to communicate with clients that superficial skin infections can take three to four treatments to achieve resolution and deep infections typically take longer. Combining fluorescence photobiomodulation with other topical treatments and addressing the underlying cause of the infection can lead to even higher success rates.

Studies in dogs demonstrated that Phovia™ as a sole therapy even speeds the time to healing by 36% in canine superficial pyoderma as compared to dogs receiving oral antibiotics alone. In one study, dogs with superficial pyoderma were treated with Phovia™ alone or with an oral antibiotic alone. Dogs treated twice weekly with Phovia™ demonstrated complete clinical healing in 2.3±0.7 (p<0.05) whereas dogs receiving an oral antibiotic healed in 3.75±1 weeks. Additionally, it has been demonstrated to speed time to healing by nearly 50% in deep pyoderma when used with an oral antibiotic (5.7 weeks of treatment) compared to dogs receiving only oral antibiotics (11.7 weeks of treatment).

Role in Wound Treatment

Fluorescence photobiomodulation can aid in wound healing. The authors typically use it in conjunction with other wound management therapies. It has been used successfully in the management of wounds in dogs, cats, and horses. In a study on canine surgical wounds, fluorescence photobiomodulation was found to increase the expression of factors that play a role in epithelial growth and collagen deposition such as factor VIII, epidermal growth factor, decorin, and collagen III, while decreasing the expression of the pro-inflammatory marker, TNF-∝, when compared to untreated skin. On histological evaluation, the treated skin was found to have less inflammation of the dermis, greater and more regular collagen deposition, and high neoangiogenesis.

CONCLUSION

Studies over the last 50 years demonstrate photobiomodulation as an effective and safe treatment for dermatological conditions. The ability of fluorescence photobiomodulation to eliminate or significantly reduce the duration of exposure to antibiotics in veterinary species will decrease the spread of antibiotic-resistant bacterial strains within pets and people. Veterinarians continue to play an important role in the One Health initiative, and application of Phovia™ in everyday cases will contribute to this standard of care.

ANNETTE LUNDBERG DVM

Dr. Annette Lundberg obtained her DVM degree from the University of Minnesota. She completed a rotating internship at the ASPCA Animal Hospital in New York City and a specialty internship in dermatology at the University of Minnesota before coming to Auburn University for her residency.

AMELIA WHITE DVM, MS, DACVD

Dr. Amelia White received her DVM degree from the University of Georgia College of Veterinary Medicine. She was accepted to a dermatology residency at the University of Illinois at Champaign-Urbana the following year. Dr. White became a diplomate of the American College of Veterinary Dermatology in 2014 and is an associate clinical professor of dermatology at Auburn University College of Veterinary Medicine.

Wound on the shoulder of a horse caused by unknown trauma. The wound was treated with Phovia™ (two consecutive treatments once weekly) in combination with standard of care wound management including a tie-over bandage. Image courtesy of Drs. Annette Lundberg and Amelia White.

YOUR INVITATION TO Experience the Difference

10th Anniversary

SEPTEMBER 14-17 | Tampa, FL

Our world-class veterinary conference is coming to Tampa, FL this September! The Gulf-Atlantic Veterinary Conference (TGAVC) is the FVMA’s deluxe small animal and exotic veterinary conference. Back for its 10th year, TGAVC offers over 260 hours of top-tier, RACE-approved continuing education (CE) for the entire veterinary team at luxurious, seaside destinations that are sure to leave attendees relaxed and ready to learn.

Wet lab & session topics include:

ƒ Anesthesia/Pain Control

ƒ Cardiology

ƒ Clinical Pathology

ƒ Dentistry

ƒ Dermatology

ƒ Feline Medicine

ƒ Internal Medicine

ƒ Oncology

ƒ Ophthalmology

ƒ Practice Management

ƒ Surgery

ƒ Urology

ƒ and more!

FVMA MEMBERS CAN SAVE UP TO $200 OFF THEIR CONFERENCE PASS

Continuing Education Hours:

More than 260 CE hours

ƒ 12 hands-on wet labs

ƒ Maximum of 27 CE hours for veterinarians

ƒ Maximum of 16 CE hours for veterinary technicians

Featured Speakers & Wet Lab Instructors

Over 35 nationally and internationally recognized speakers and instructors!

Jonathan Abbott

DVM, DACVIM (Cardiology), DSACS, UT-CVM

Cardiology

Jan Bellows

DVM, DAVDC, DABVP

Dentistry

Timothy Hackett

DVM, MS, DACVECC

Emergency Medicine

Gary Oswald

DVM, MS, DACVIM

(Internal Medicine)

Internal Medicine

Ashley Smith

DVM, MS, DACVIM (Oncology)

Oncology

Edwin Bayó

JD

Administrative & Regulatory Law

Jen Brandt

LISW-S, PhD

Wellness

Jessica Martinez

MS, DVM, DACVO

Ophthalmology

Howard B. Seim III

DVM, DACVS

Surgery

Peter Weinstein

DVM, MBA

Practice Management

Thank you TO OUR EDUCATIONAL PARTNERS & SPONSORS!

Wet Labs

Reserve your seat for one of our 13 hands-on wet labs.

Our wet labs are your chance to get hands-on instruction from experts in their field. You’ll get ample opportunity to practice your skills while supervised by our esteemed instructors, who will provide helpful tips and feedback. Don’t miss this opportunity to learn from the best and take your practice to the next level!

Veterinarians can save $200 and technicians can save $55 on wet labs when purchased with a conference pass!

Featured WET LABS

STIFLE EXPLORATORY AND EXTRACAPSULAR ACL REPAIR (for DVMs)

4 CE HOURS: Learn the technical aspects of some important orthopedic surgery procedures of the stifle. This includes surgical conditions commonly seen in veterinary practice, such as stifle arthrotomy, exploration of the stifle joint, and extracapsular stabilization for ruptured cranial cruciate ligament (CrCL).

ULTRASOUND FOR TECHNICIANS (for Techs)

4 CE HOURS: An introduction to entry-level abdominal ultrasound imaging as well as elements of Point-of-care Emergency FAST Scans in the small animal practice. Participants learn basic ultrasound image manipulation (knobology), the physics of abdominal ultrasound, critical care protocols, scanning techniques, and how to identify normal abdominal structures.

SURGERY WET LABS

• Soft Tissue Surgery Boot Camp - DVM only | 8 CE

• Ophthalmic Surgery - DVM only | 5 CE

• Next Steps in Soft Tissue Surgery - DVM only | 8 CE

DENTISTRY WET LABS

• Basic Canine Extraction Techniques - DVM only | 4 CE

• Feline Extraction Techniques - DVM only | 4 CE

• Dental Nerve Blocks Cleaning, Probing, & Charting - Tech only | 4 CE

• Dental Radiology Positioning Techniques - Tech only | 4 CE

ULTRASOUND WET LABS

• Basic Small Animal Abdominal Ultrasound - DVM only | 8 CE

• Advanced Small Animal Abdominal Ultrasound - DVM only | 8 CE

• Veterinary Point-of-care for Everyday Practice - DVM only | 8 CE

Venue and Hotel

Tampa Marriot Water Street

505 Water Street | Tampa, FL 33602

Rise to any occasion at our host hotel, the Tampa Marriott Water Street, in downtown Tampa, FL. Featuring spacious, petfriendly hotel rooms with modern layouts, sophisticated décor, and private balconies with views of the water or downtown Tampa skyline, we know the Marriott is sure to please!

Book your room online by scanning the QR code.

Discounted rates are valid until August 23, 2023, or until the room block is SOLD OUT!

Child Care Services

Provided by Kiddie Corp

Special Discounted Rate: $12.00/HOUR

Busy parents can get their CE while the kids enjoy a program they are excited about. Discounted day care services are available Sept. 1516 at Tampa Marriott Water Street for children from six months of age through 12. Register early as availability is limited!

A Veterinarian's Guide to PREPARING FOR A HURRICANE

Jillian Sinclair | Marketing Specialist Florida Veterinary Medical Association

When natural disasters like hurricanes strike, veterinarians play a critical role in safeguarding the lives of animals under their care. Proper preparation is essential to ensuring the safety and well-being of these animals during and after such events.

In this article, we will explore the key considerations that veterinarians must take into account when preparing for natural disasters like hurricanes. By addressing these factors, veterinarians can effectively protect and care for the animals in their care, minimizing the long-term impacts of these catastrophic events.

ASSESS THE VULNERABILITY OF YOUR PRACTICE

To ensure the safety and well-being of all involved, veterinarians must assess the vulnerability of their facilities and develop comprehensive plans to mitigate potential risks.

Identifying Potential Hazards: Identify the specific natural disasters that commonly occur in your region, with a focus on hurricanes. Understanding the risks associated with hurricanes, such as strong winds, flooding, power outages, and infrastructure damage, provides a foundation for effective preparedness.

Assessing Facility Location: Evaluate the geographic location of your veterinary practice to determine its susceptibility to hurricane impacts. Consider factors such as proximity to coastlines, flood zones, and historical storm patterns. This assessment will help you gauge the level of risk your practice faces and inform your preparedness efforts.

Conducting a Structural Assessment: Hire a professional engineer to evaluate the structural integrity of your facility well before hurricane season. Their expertise can identify any weaknesses or areas vulnerable to hurricane damage. Assess the foundation, walls, windows, roof, and doors for potential improvements. Implement necessary repairs or reinforcement measures to strengthen the structure if required.

Reviewing Utility Systems: Evaluate the functionality and resilience of essential utilities such as electricity, water, natural gas, telephone, and internet services, and sewage systems. Assess backup power options, including generators, to ensure continuous operation during power outages. Consider flood mitigation measures if the facility is in or near a flood zone.

Image courtesy of Canva.

Information for this article was provided by Drs. Terry Clekis and Lawrence Garcia. Images courtesy of Dr. Terry Clekis.

BEFORE THE STORM

Once veterinarians have fully assessed their practice, it’s time to create a detailed plan of how they will prepare for a hurricane. While we can’t plan for every kind of natural disaster, hurricanes give us enough warning that veterinarians should have a preparation routine to practice before the storm hits.

Veterinarians can refer to this checklist of important supplies they should have prepared before the hurricane hits their area. They should be sure to keep supplies in a safe place that is least likely to become damaged during the storm and ensure the items are rotated/replaced regularly to prevent expiry.

Developing an Evacuation Plan: Create a comprehensive evacuation plan for animals, staff, and clients. Establish a transport plan, designated evacuation routes, and safe destinations where animals can be safely housed and receive care. Consider also having a plan to shelter in place if unable to evacuate.

Securing Vital Records: Make digital copies of essential records, such as medical histories, vaccination records, and client information. Be sure to back up your practice management software in case it gets damaged during the storm. Store these backups in a secure, off-site location or cloud-based storage system. This measure protects important data in case of physical damage to your practice.

Creating an Emergency Supply Kit: Prepare an emergency supply kit that includes essential items such as first aid supplies, medications, food, water, and bedding for

animals. Additionally, stock up on emergency equipment like generator(s), fuel, flashlights, batteries, radios, and portable fans to ensure you are well-prepared for any contingencies for at least seven to 10 days.

Training Staff Members: Conduct regular training sessions to educate your staff on disaster preparedness and response protocols. Ensure they understand their roles and responsibilities during emergencies, including animal evacuation, sheltering in place, first aid, and communication procedures. Practice drills can help improve response efficiency and coordination.

Maintaining Insurance Coverage: Review your insurance policies to ensure they provide adequate coverage for potential hurricane damage. Consider additional coverage options such as flood and wind insurance. Regularly review and update your policies to align with your evolving needs. To be safe, it is a good idea to video around your clinic to show what equipment you have and what it looked like before the storm in case there is severe damage. This ensures you have a record of exactly what you had prior to the storm for your insurance company.

Gathering Emergency Contacts: Compiling a list of emergency contacts, including local animal control agencies, nearby veterinary hospitals or clinics, county emergency management officials, and relevant authorities, is crucial. This ensures prompt coordination and access to additional resources if needed, enabling veterinarians to provide comprehensive care and support during a crisis.

Planning for Communication and Notification: Effective communication channels are essential for veterinarians to keep owners, staff, and relevant parties informed about evacuation plans, safety protocols, and updates during and after the disaster. Utilizing phone trees, social media, and other means of communication facilitates efficient information dissemination and ensures the wellbeing of both animals and their owners.

Identifying Animals: Maintaining accurate records and identification for each animal is paramount during a disaster. Microchipping, tagging, or using other identification methods can greatly assist in reuniting lost or displaced animals with their owners after the event. This step helps ensure a seamless reunification process.

Securing the Facility: Prior to a hurricane, veterinarians should reinforce the windows and doors of the veterinary clinic or hospital, remove any potential flying debris, and verify the structural integrity of the building.

Hurricane SUPPLY CHECKLIST:

Medical Supplies

☐ Basic first aid kits with bandages, gauze, and wound cleansers

☐ Sterile surgical instruments and suture materials

☐ Medications for pain relief, wound management, antibiotics, gastrointestinal issues, allergies, and parasites

☐ IV fluids and administration sets

☐ Syringes, needles, and catheters of various sizes

☐ Eye and ear care solutions

☐ Small and large nail clippers

☐ Suture scissors, bandage scissors, small sharp scissors, and kitchen shears

☐ Examination gloves in multiple sizes

☐ Distilled water

☐ Scalpel holders

☐ Sterile lube packets

☐ Antibiotic ointment

☐ Silver nitrate sticks

☐ Alcohol swab

☐ Sharps box

☐ Clippers and blades

☐ Surgical gowns, masks, gloves, and Bouffants

Restraint & Handling Equipment

☐ Muzzles of different sizes

☐ Gloves and personal protective equipment

☐ Restraint devices such as leashes, collars, and harnesses

☐ Towels and blankets to restrain or transport injured animals

☐ Transport carriers

Diagnostic Equipment

☐ Stethoscope

☐ Microchip scanner

☐ Portable ultrasound machine

☐ Thermometers

☐ Blood pressure monitors

☐ Ophthalmoscope and otoscope

☐ Portable X-ray machine

☐ Blood and urine testing kits

☐ Microscope

☐ Glucometer with lancets and glucose strips

Shelter & Environmental Equipment

☐ Portable kennels or cages

☐ Heating pads and blankets

☐ Portable generators or battery-operated equipment

☐ Flashlights and headlamps

☐ Waterproof tarps or plastic sheeting

☐ Cleaning supplies, disinfectants, and waste disposal tools

☐ Ventilation equipment

☐ Potable water, food, and water bowls

Communication & Documentation

☐ Cell phones

☐ Two-way radios

☐ Satellite phone

☐ Emergency contact information for local , regional, and state animal control agencies, animal hospitals, and rescue organizations

☐ Digital or paper forms for recording patient information, treatment plans, and medication administration

DURING THE STORM

When a hurricane strikes, the safety of veterinary staff, as well as the welfare of their patients, becomes top priority. Veterinary clinics and hospitals must be well-prepared to navigate disaster preparation, response, and recovery effectively.

Ensuring Staff Safety: Above all else, the well-being of veterinary staff must be protected during a hurricane. Clear instructions should be given to follow local evacuation orders and avoid unnecessary risks. Prioritize staff safety by providing them with necessary resources, such as safety guidelines, emergency contact information, and guidance on evacuation routes. Regular communication should be maintained to keep staff informed about the hurricane's progress and any changes in protocols.

Providing Care to Hospitalized Patients: In situations where the veterinary clinic remains operational during the hurricane, special attention must be given to the well-being of hospitalized patients. Adequate care and monitoring should be provided, ensuring that patients are comfortable, and their medical needs are met. It is crucial to have sufficient supplies, including food, water, medications, and medical equipment, to sustain patient care during the storm. Backup power generators and systems should be in place to mitigate the impact of potential power outages. It is also important to have plans to house staff +/- their families, and a plan to rotate out staff every 12-24 hours.

Communicating With Clients: Effective communication with clients is essential during a hurricane. A well-prepared communication plan should be in place to keep clients informed about the clinic's status, emergency contact information, and any changes in service availability. Utilize various communication channels, such as social media, email, phone calls, or text messages, to relay important updates to clients. Regularly update the clinic's website or social media platforms to ensure accurate and timely information is available.

AFTER THE STORM

In the aftermath of a hurricane, veterinarians play a critical role in assessing and addressing the damage caused, ensuring the well-being of their patients and clients, and collaborating with local authorities and animal welfare organizations. As the storm subsides, veterinarians must swiftly evaluate the physical condition of their clinics, prioritize urgent cases, reschedule appointments, and provide updates to clients regarding reopening and service availability. This phase requires effective coordination, communication, and

adaptability to navigate the challenges brought forth by the hurricane's impact.

Assessing and Addressing Damage: Once the hurricane has passed, veterinarians must conduct a thorough assessment of the clinic's physical condition. This includes examining the building structure, equipment, and any potential safety hazards. Any damage or safety issues should be addressed promptly to ensure a safe environment for both staff and patients. In cases where the facility is not functional, veterinarians should make arrangements for relocation or alternate care options to continue providing essential veterinary services.

Contacting Clients and Rescheduling

Appointments: Open and effective communication with clients is crucial during the post-hurricane period. Veterinarians should promptly contact clients to reschedule appointments that were postponed due to the hurricane. Various communication channels should be utilized to disseminate information regarding the clinic's reopening, revised operating hours, and appointment availability. By keeping clients informed, veterinarians can alleviate concerns and maintain trust within the community.

Prioritizing Urgent Cases: After a hurricane, there may be a surge of animals in need of immediate veterinary care. Veterinarians must prioritize urgent cases based on the severity of the condition. Critical cases requiring immediate attention should be promptly addressed, while non-urgent cases can be rescheduled accordingly. It is important to allocate resources efficiently, ensuring that all animals receive the necessary care and attention during this challenging time.

Coordinating with Local Authorities and Animal Welfare Organizations: Collaboration with local authorities, disaster management agencies, and animal welfare organizations is crucial in post-hurricane recovery efforts. Veterinarians should actively participate in coordinating resources, providing assistance, and sharing information to support the affected community. By working together, they can ensure a more comprehensive response, effectively address animal welfare concerns and contribute to the overall recovery process. Some associations and entities veterinarians should consider becoming involved with are:

• Local veterinary practices and practitioners

• Pharmaceutical distributors

• Local pharmacies

• Regional animal medical emergency facilities

• Florida disaster relief groups such as:

Florida State Agricultural Response Team (SART)

Florida SART is a collaborative group of government and private organizations committed to enhancing disaster preparedness across all types of emergencies. Its main focus is to facilitate a well-coordinated and efficient response for the animal and agricultural sectors in Florida.

Florida Veterinary Corps

To aid in emergencies involving animals, the FVMA, University of Florida College of Veterinary Medicine, and Florida Department of Agriculture and Consumer Services have created a volunteer corps of veterinarians and technicians. Volunteers assist response teams at local, state, and national levels, addressing animal and human needs. These professionals form part of the State Agriculture Response Team (SART) and serve under Emergency Support Function (ESF) 17 and the State Emergency Response Team. They contribute to assessing veterinary response capabilities, providing emergency animal treatment, and supporting disease surveillance and control efforts for Florida's animals.

Ensuring that veterinarians are well-prepared for hurricanes is crucial for safeguarding the well-being of both animals and their owners during these natural disasters. By developing comprehensive emergency plans, stockpiling necessary supplies, and conducting regular training exercises, veterinarians can effectively respond to the unique challenges posed by hurricanes. Collaboration with local authorities, veterinary associations, and community organizations is vital for sharing resources and expertise.

Ultimately, the proactive preparation of veterinarians plays a vital role in minimizing the impact of hurricanes on the welfare of animals and promoting a swift recovery for affected communities.

TERRY CLEKIS

DVM, MS

Dr. Terry Clekis has served as the FVMA’s Disaster Preparedness Committee chair since 2010, where he is responsible for ensuring that all veterinary hospitals have a plan of action for their clients and patients in the event of a natural disaster.

LARRY GARCIA

DVM, MS

Dr. Lawrence “Larry” Garcia is a clinical assistant professor and medical director for the Veterinary Emergency Treatment Service (VETS) Team at the University of Florida College of Veterinary Medicine.

Veterinary volunteers with a hurricane-impacted patient.

Dr. Terry Clekis (left) assisting with a medical procedure on hurricanedisplaced patient.

Helping Animals and People During Disasters: FLORIDA VETERINARY CORPS

When disaster strikes, both animals and people are in need of urgent assistance. With the 2023 Atlantic hurricane season in full swing, the Florida Veterinary Corps urgently calls for more veterinarians and technicians to join their cause and support the community during crises.

This volunteer-driven program aids local officials in responding to animal emergencies. Volunteers are an essential lifeline for animals in distress, and their expertise can be the difference between life and death, providing comfort and relief to both animals and their owners when they need it most.

If you are a veterinarian or veterinary technician and able to volunteer, please consider joining the Florida Veterinary Corps before the next natural disaster strikes. By joining the Corps, you have the power to save lives, provide relief, and make a meaningful impact on both animals and people affected by natural disasters.

JOIN THE FLORIDA VETERINARY CORPS

TODAY!

Scan here!

Online Course:

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New- Gulf Coast Panhandle- Unique opportunity to buy "Sister Practices" 1 grossing $1.2M, & 1 grossing almos t $1.1M Prx+RE

S.E. Florida- 1 Dr. small anima l, Palm Beach C o . Lease spac e with 2 exam rooms and room for a 3rd. $1.1M gross, ADI $242K.

Eastern Panhandle- Solo Dr. with $1.05M gross. 2300 sq.ft. hospital on almost 3 acres. After debt income of $265K.

Treasure Coast- 2 Dr. SA in a beautiful, affluent area of the Atlantic Coast. 2022 gross of $1.8M, nice lease space, very wel l equipped.

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FLORIDA LAWS AND RULES & DISPENSING LEGEND DRUGS

Our updated three-part course satisfies Florida’s mandatory continuing education (CE) requirement for license renewal of no less than one hour of CE in the area of dispensing legend drugs and two hours of CE in the area of the laws and rules governing the practice of veterinary medicine.

KEY TOPICS include:

• The disciplinary process and guidelines

• Record-keeping requirements

• Appropriate drug dispensing practices

• DEA regulations

• Common causes for disciplinary action and how to avoid them

• Recent statutory, regulatory, and case law developments

Note: This course is approved by the Florida Board of Veterinary Medicine, Provider #0001682.

PRICING

FVMA members: $99.00

Non-member: $149.00

UNLEASHING WORKPLACE WELL-BEING: A Veterinary Take on the Surgeon General's New Workplace Priorities

Philip Richmond | DVM, CAPP, CPHSA, CCFP Flourishing Phoenix Veterinary Consultants

In 2022, the U.S. Surgeon General outlined a set of priorities for workplace well-being that reflect the changing landscape of work in the post-pandemic era. Recognizing the importance of employee mental health and well-being as crucial factors for organizational success, these priorities focus on fostering a supportive and inclusive environment that adapts to the evolving psychological and emotional needs of the workforce.

From addressing remote work challenges to prioritizing mental health and promoting equity, the Surgeon General's 2022 priorities emphasize the essential role of employers in nurturing a healthy and engaged workforce.

How can we take the U.S. Surgeon General's priorities for mental well-being in workplaces and apply them to our veterinary hospital environments? How can protection from harm, connection to community, work-life harmony, mattering at work, and opportunities for growth — all centered around worker voice and equity — deliver reduced burnout, protection from psychological harm, and promote a flourishing workplace experience in veterinary medicine?

HERE ARE THE PRIORITIES seen through a veterinary lens:

1. PROTECTION FROM HARM: In veterinary hospitals, we're all passionate about patient care. We must remember to take care of ourselves and our team members too! By establishing anti-bullying and anti-harassment policies, offering training to level-up skills of resiliency, managing compassion fatigue and burnout, improving access to mental health professionals, assessing job demand, and fostering a culture that values psychological safety and self-care, we can create that place we all want to work.

2. CONNECTION TO COMMUNITY: You know that warm, fuzzy feeling when you're part of a tight-knit group? Yes! A sense of belonging is a big part of our well-being at work. Evidence shows that belonging’s opposite – isolation at work – is quite painful for us. Onboarding focusing on connection, team-building activities, social events, and open communication channels can help create strong connections between staff members. This can turn our hospitals into an oasis. We spend a significant percentage of our time at work. Why wouldn’t we want to make it as welcoming as possible?

Image courtesy of Canva.

3. WORK-LIFE HARMONY: Let's help our staff achieve healthy work-life integration by offering flexible schedules and accommodating personal commitments. The old “leave your stuff at the door” saying is not possible or realistic. We bring our humanness with us where we go. Adding resources for resilience training, stress management, mindfulness resources, and exercise opportunities can also be helpful.

4. MATTERING AT WORK: Who doesn't want to feel valued, respected, and recognized for their hard work? Let's make sure our veterinary team knows they're making a difference. By providing regular feedback, professional development opportunities, and recognition programs, we can show our appreciation and let our teams know we care.

5. OPPORTUNITY FOR GROWTH: Great things happen when we invest in our employees' growth and development. By offering continuing education, skill-specific workshops, mentorship opportunities, and career advancement initiatives, our teams will be equipped to reach their full potential and thrive in their roles.

By focusing on these key priorities, we can create a supportive, inclusive, and downright enjoyable atmosphere for everyone.

WORKER VOICE AND EQUITY: Let's Talk!

This is the foundation and central focus of the Surgeon General’s initiative. We want everyone to have a say in how things are run. To that point, have we intentionally created an environment where everyone feels safe to share and take risks? By actively seeking input from employees, ensuring their voices are heard, and creating a psychologically safe space for it — we can. We also create a more inclusive and equitable environment. Embrace diversity, provide equal access to opportunities and resources,

DR. PHILIP RICHMOND

and value everyone's unique perspectives and experiences. This is the way.

THE RESULT? Happier, healthier, and more successful veterinary workplaces.

By adapting these priorities for well-being to our individual veterinary environments, we can create that vision I had in veterinary school — like the show “Scrubs,” but better. Truly when we make these priorities our mission, when we focus on our teams’ voice and equity, we will watch our hospitals transform into sustainable and rewarding places we come to find joy, meaning, and purpose.

Dr. Philip Richmond is a graduate of the University of Florida College of Veterinary Medicine (UFCVM) and is the medical director of Country Oaks Animal Hospital in New Port Richey, Florida. He currently serves as chair of both the Florida Veterinary Medical Association’s Outreach and Professional Wellness & Wellbeing Committees. He is a member of the Workplace Suicide Prevention & Postvention Committee (AAS/AFSP), The Veterinary Medical Association Executives Wellbeing Committee, and UFCVM Wellbeing Curriculum Committee. Dr. Richmond is one of 4 co-founders of the Veterinary Wellbeing Collective and the founder of Flourishing Phoenix, Veterinary Wellbeing & Engagement Consultants. He has also served on the board of directors of the Florida Medical Professionals Group, an organization that supports medical professionals in recovery in the state.

Dr. Richmond is a published writer, veterinary wellbeing advocate and speaker, and frequent veterinary podcast guest. He holds multiple certifications in the fields of applied positive psychology, positive psychology consulting, resilience training, workplace wellbeing, and team culture. Dr. Richmond was awarded a FVMA Gold Star for service in 2019 and Veterinarian of the Year in 2021. He is married to Dr. Carla Channell, also a veterinarian. They have two children, three dogs (an Aussie, a Beagle/Dachshund, and a Maltese/Affenpinscher), a bevy of cats and turtles, a sulcata tortoise, a ball python, and a corn snake. He is a Krav Maga practitioner and enjoys weightlifting and functional training.

DVM, CAPP, CPHSA, CCFP

A NOTE from Staff

Dear Recent UFCVM Graduate,

Congratulations on your academic rigor and scholarly success – we are proud of you for persevering! Our reps, Drs. Hester, Carpenter, and Kesser were so happy to join you at your coating ceremony and celebrate your graduation. As you take this next big (and exciting) step of your career and enter the workforce, know that the FVMA walks with you.

We know it can be hard when you’re first starting out, that’s why we’re offering you FREE FVMA membership for your first year. We are here to help support your journey and offer many helpful resources from job postings to legal advice to discounts on products you know and love. Please know you can rely on us to help you! Give us a call at (407) 851-3862 or check us out at fvma.org.

Once again, congratulations on your graduation!

FVMA Staff

PRACTICE Pulse

QUESTION: I am a DEA-registered practitioner. I heard that the DEA is now requiring all practitioners to take eight hours of training on managing and treating opioid or other substance use disorders. Where can I take this course?

A: Veterinarians are NOT required to take the training on treating and managing patients with opioid or other substance use disorders. The DEA has advised that a checkbox for this training appears as a requirement on the online registration application. However, any veterinarian who is registering for the first time or renewing their DEA registration simply needs to check a box on the application that affirms “read and understood” the information about the training requirement.

QUESTION: The new non-permitted concealed carry law goes into effect July 1. We would like to have a hospital policy sign stating that firearms are not allowed in the building but must stay locked in a car in the parking lot. Is there specific verbiage needed on the policy? Does a simple ‘no firearms’ sign on the door suffice? We would like to have something lighthearted, but would that meet a legal requirement?

A: A business is authorized to post a sign that states that no concealed weapons are allowed on the premises, but there is no violation of any law if a customer disregards the sign. There is no specific verbiage required.

If you are looking for something lighthearted, how about:

“Our patients hate the sound of gunfire, so we ask that you keep your firearm securely locked in your vehicle.”

QUESTION: We have a new veterinarian at our clinic, and she has concerns regarding dispensing medications for my clients when I am not available. We keep paper records on every client/patient and require yearly checkups to continue dispensing medications.  Does my associate have to examine a patient (even if I have seen the patient in the last year) in order to refill medication that the patient has had in the past and/or to dispense medication? For example, if the client drops off a urine or fecal sample and we need to dispense antibiotics.

A: A veterinarian working at a practice can dispense medication for an established patient of the practice that has been examined by another veterinarian at the practice. So long as the second veterinarian has access to the records and can confirm that the medication is appropriate based on the diagnosed condition and that any required testing has been done, the second veterinarian does not have to examine the patient.

QUESTION: Can you please send me the Florida statutes regarding firing a client? Specifically, I am curious if the letter has to be sent certified.

A: There is no statute on firing a client. A certified letter is better, but not required. If you have an e-mail address for the client, sending an additional e-mail (or a PDF copy of the letter) by e-mail is a good idea.

The letter firing a client does not have to give any reason, other that something along the lines of:

“We regret that we are unable to continue providing care to your pet (name or description). For the next 30 days, we will remain available only for emergency care. We urge you to make prompt arrangements with another veterinarian to ensure continuity of care, and we will forward a copy of the patient records to any veterinarian that you so designate.”

QUESTION: Is there any legal requirement for a small animal practice to provide public restrooms to their clients. Over the last couple of months, we have had to call the plumber out three to four times, and we are wondering if we can deny access.

A: Having a restroom is required according to 61G18-15.002(2) (a), which details the minimum standards for premises where veterinary medicine is practiced.

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.-5 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.

QUESTION: I have recently moved to a new veterinary clinic and have been contacted by my previous clinic about rabies certificates that require signatures. To clarify, these are vaccinations that I performed when I was employed at that clinic, but the owner misplaced their certificate, and we do not have one on file scanned into the medical record. Since I am not present to sign the certificates, and we do not have a rubber stamp at that clinic, is my practice manager able to sign for me and initial? Or how should this be handled?

A: They can mail them to you, the veterinarian, for your signature, or you can stop by and sign them yourself. One should not delegate to anyone the signing of any rabies certificate.

QUESTION: Is a relief veterinarian forced to use their DEA license at a facility if the veterinarian does not have a certain narcotic? Isn't it true you can have your own DEA license as a relief veterinarian 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: I have a situation regarding a puppy that was sold with a health certificate. Not more than a week after, the puppy was not eating well and began having seizures. What is my client’s recourse in a situation like this? Can she get a refund from the breeder?

A: Florida’s Pet Lemon Law offers protection for the buying client in instances where a dealer may misrepresent the breed, sex, or health of any dog sold within the state. Florida law defines a pet dealer as anyone who sells more than two litters or 20 dogs/cats to the public during the course of a year. This definition does not apply to county- and city-operated animal control agencies and registered nonprofit humane organizations.

Those who purchase a pet that is later determined to be unfit by a veterinarian have three options:

- Return the animal for a full refund, including any taxes and fees, and a reimbursement for the veterinary cost related to the dog.

- Exchange the animal for one of equal value in lieu of a refund. If they choose an exchange the dog, they are still entitled to veterinary reimbursement.

- Keep the animal. Those who wish to retain the dog may do so (unless they signed an agreement waiving this right at the time of purchase). If the consumer chooses to keep the animal, the dealer must pay for reasonable veterinary expenses to treat or cure the dog.

The Pet Lemon Law allows the following:

- Consumers have 14 days to document contagious or infectious disease and one year to document congenital or hereditary defects.

- Consumers must notify the pet dealer within two business days of the veterinarian's determination that the animal was unfit.

- Consumers have three days to provide the seller with written certification of the animal’s unfitness.

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

PRACTICE FOR SALE/LEASE

PRACTICE FOR SALE – MIAMI-DADE/BROWARD: Are you desiring autonomy and a flexible schedule? Fantastic opportunity for $110K financed. Housecall practice, south FL, established 16 years, owner retiring. Friendly clients, with no emergencies and, less than 20 hour/week. Contact Fernando at 561-6097371 or fmello@tworld.com

6 PRACTICES FOR SALE: Six Florida practices for sale at a discount by an 83-year veterinarian who due to health reasons is very motivated to sell! All six clinics have digital X-ray, AVImark, in-house lab equipment, etc. 407-529-5651 and ask for LG.

PRACTICE & SATELLITE CLINIC FOR SALE – TAMPA BAY, FL: Solo practice retiring. An independent building, 2,000 sq ft, (lease or buy) and a satellite clinic (leasehold) in Tampa Bay. No ER and low overhead. Gross $470,000++. Asking $340,000 (negotiable & owner financing). Only serious buyers. Email lovevet1234@gmail.com for more information.

VETERINARY PRACTICE SPACE FOR LEASE IN ORLANDO FLORIDA: Established Veterinary Hospital for over 35 years. High visibility, free standing building, over 6000 square feet, on the corner of East Colonial Drive and Goldenrod in Orlando. Please call 714-791-4310 or email - hrfdvm@gmail.com

PRACTICE FOR SALE – MIAMI DADE - WITH OR WITHOUT REAL ESTATE: Small Animal Hospital in Miami, Florida – Free Standing building for purchase or lease. Options open. US1 and Pinecrest area. Established, turnkey, loyal clients and staff. Loss of associate forcing sale. Ready to have your own practice? Ownership can be easy and obtainable. Contact: Brian 305-984-7654 or email bemden@bellsouth.net

EQUIPMENT FOR SALE/LEASE

EQUIPMENT FOR SALE – WABASSO, FL: Available September 2, 2023: Digital x-ray, 300 MA, $12.5k obo. Idexx VetLab, LaserCyte, Catalyst Dx, and SnapPro, $5.5k obo. Stainless cages: 8 24 inch, 4 36 inch, 1 48 inch, $3900 obo. Inquiries email docmoon@bellsouth.net

Florida Practices for Sale

DUVAL COUNTY - #FL124

Solo practice in a 1,400 SF leasehold facility with 2 exam rooms. 2022 gross revenue $700K. Excellent location!

BROWARD COUNTY - #FL120

Solo practice in a 1,600 SF leasehold facility with 2 exam rooms. 2022 gross revenue $724K. Growth potential!

HILLSBOROUGH COUNTY - #FL119

Solo practice with real estate. 2,400 SF facility with 2 exam rooms and the ability for a 3rd. Gross revenue $1.05M.

BREVARD COUNTY - #FL118

Solo practice with real estate. 2,500 SF facility with 3 exam rooms. 2022 gross revenue $752K. ALL OFFERS WELCOME!

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