FVMA Advocate Issue 3, 2020

F V M A ADVOCATE ISSUE 3 | 2020

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THE PRESIDENT OF THE FLORIDA VETERINARY MEDICAL ASSOCIATION

Mary Smart, DVM

President's Message 7207 Monetary Drive Orlando, Florida 32809 Phone – 407.851.3862 Toll-free – 800.992.3862 Fax – 407.240.3710 info@fvma.org | www.fvma.org

OFFICERS

Dr. Mary Smart President Dr. Marta P. Lista President-elect Dr. Donald H. Morgan Treasurer Dr. Michael Epperson Past President Mr. Philip J. Hinkle Executive Director

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

Greetings colleagues, I hope this finds you, your families and team members well as we journey through the COVID pandemic. Certainly, no one is left untouched by this world crisis. I want to thank each and every one of you as you continue to care for the animals of Florida despite these challenging circumstances.

Despite the creation of a “new normal” in our workplaces, I feel continually blessed. My colleagues and friends amaze me as we adapt to the needs and requirements of these times. Clients and staff rise to the occasion, showing grace, compassion and understanding to one another.

Our patients are incredible. They are now oftentimes examined, without their owners, by people wearing masks. I know we will carry this strength with us as we move forward in our efforts to ease out of the initial restrictions. Please continue to support each other and reach out to each other when help is needed. I look forward to the summer and hope it offers us a new season of recovery.

The University of Florida College of Veterinary Medicine had their virtual graduation ceremony on May 23, 2020. 113 students joined our ranks as doctors and colleagues in the veterinary profession.

Please welcome these graduates as you meet them in the workplace and offer thoughtful mentorship and guidance to these new veterinarians. We have so much to offer to each other.

The FVMA is dedicated to keeping all veterinarians in Florida informed. We will continue to send out pertinent and timely information as the staged reopening of business unfolds in Florida.

As fall approaches, the FVMA will keep membership updated on upcoming conferences, such as The Gulf-Atlantic Veterinary Conference (December 3-6, 2020) in Boca Raton, Florida. We will continue to provide our members with world-class continuing education so that we may all continue to learn and grow.

With a gracious heart,

Mary Smart, DVM

Dr. Dana Nicole Zimmel Dean, Ex Officio

FVMA MISSION:

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

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

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In Remembrance Howard Pierce Bouchelle, DVM Dr. Howard Pierce Bouchelle, 43, passed away on April 5, 2020.

Dr. Bouchelle was born (1977) and raised in Jacksonville, Florida.

From a young age, he knew he wanted to be a veterinarian and cared for a myriad of pets throughout his life.

He attended the University of Florida with a double major in chemical engineering, and microbiology and cell science with a minor in chemistry. He received his DVM from the University of Florida College of Veterinary Medicine in 2003. Even after his college career, he remained an avid Florida Gators football fan and tried to attend every home game. Dr. Bouchelle built a stellar reputation working in California, South Florida and northeast Florida. In 2015, he founded Intracoastal West Veterinary Hospital, which opened in July of 2016. His interests included dermatology,

dentistry, ophthalmology and cardiology.

Outside of work, Dr. Bouchelle enjoyed travelling, road tripping and gardening.

Dr. Bouchelle was an active member of the American Veterinary Medical Association, Florida Veterinary Medical Association and Jacksonville Veterinary Medical Society. He was a Life Member of the University of Florida Alumni Association, a parishioner of Saint Paul's Catholic Church, and godfather and sponsor to his sister's children. He devoted his life to his family, friends and the animals.

He is survived by his parents, sister, niece, nephew and other extended family members.

Eugene Howard Acree Sr., DVM Dr. Eugene Howard Acree Sr. passed away at the age of 94 on March 13, 2020. Born in White House, Tennessee, he was raised in Jacksonville, Florida and attended Robert E. Lee High School.

He served during World War II in the Army Air Corps as a First Lieutenant navigator on a B17 air rescue unit. After his service, he attended Auburn University where he received his DVM. While in attendance, he also married his high school sweetheart, Emily Bond Mallard. Both were lifetime Auburn fans. Dr. Acree practiced large animal medicine and co-owned Meadowmilk Dairy with his brother, fellow veterinarian Dr. James A. Acree.

An active community member, Dr. Acree was commander of American Legion Post 137, president of the Greater Jacksonville

Agricultural Fair Board, chairman of the Jacksonville Recreation Advisory Board, vice chairman of the Florida Board of Veterinary Medicine, Duval County 4H Foundation sponsor and a board member of Duval County Soil & Water Conservation District. He was also a deacon and elder of the Ortega Presbyterian Church.

Dr. Acree is predeceased by his wife and a grandson. He is survived by his children, grandchildren, 10 great-grandchildren and two brothers.

Merrill H. McGlamery Jr., DVM Dr. Merrill H. McGlamery Jr., 74, passed away at home on January 14, 2020 after his second battle with cancer. A 1969 graduate of Texas A&M, he began practicing veterinary medicine in Georgia.

During this time, he was also doing post-doctoral studies in microbiology and virology at The University of Georgia. In June of 1973, after moving to Florida, he purchased Park Animal Hospital, Inc. in Pinellas Park, Florida and became a founding owner of the Animal Emergency Clinic in St. Petersburg, Florida.

“Dr. Mac,” as he was affectionately dubbed, lived a life filled with and fulfilled by animals.

In his spare time, he enjoyed computers, photography, boating and flying his plane.

He is survived by his wife, sister, three children, two stepdaughters, five grandchildren, one greatgranddaughter and the staff of Park Animal Hospital.

In This Issue 3 | 4 | 6 | 8 | 12 | 16 |

In Remembrance Member Spotlight Farewell to Past President Meet the New FVMA President Hurricane Preparedness UFCVM Class of 2020

19 | FVMA Presents Scholarship Awards to UFCVM Graduates 20 | Processing Worry: How Do We Work Through It? 24 | Storm and Noise Phobia in Dogs and Cats 28 | Practice Pulse 30 | Classified Advertisements WWW.FVMA.ORG |

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MEMBER SPOTLIGHTS DR. WENDY MANDESE WINS ZOETIS TEACHING AWARD Dr. Wendy Mandese, a clinical track faculty member in the primary care and dentistry service, has received the UF College of Veterinary Medicine’s 2020 Zoetis Distinguished Veterinary Teacher Award. This award is given in recognition of the instructor’s character and leadership qualities as well as their outstanding teaching abilities.

Dr. Mandese was selected based on numerous criteria, including peer and student evaluations; quality of teaching and impact on student learning; and teaching-related research, service and publishing activities. Much of Dr. Mandese’s effort is dedicated to the clinical and didactic teaching of veterinary students, focusing on teaching the core competencies associated with general practice and preventative medicine. In her courses and clerkships, she received student evaluation scores that averaged over 4.9 out of 5.

While she also lectures in cardiopulmonary disorders and in animal welfare and ethics, her most unique role at UFCVM is in her coordination of externships for students. Through a course she dubbed Practice Based Clerkship, Dr. Mandese has helped to recruit, screen and educate over 40 private practice partners in northern Florida. This has allowed students to get “real world” experience as a credit accruing course. Dr. Mandese’s efforts and courses are well-loved by students. Despite being in the largest department of UFCVM, Dr. Mandese has had the highest overall teaching scores of any faculty member in the small animal clinical sciences for the last three years.

Beyond the classroom, Dr. Mandese has also been a leader in educational scholarship. In addition to her stellar student evaluation scores, she showed innovation and hard work in establishing a unique external practice experience that is highly valued by veterinary trainees. Dr. Mandese has brought recognition to UFCVM programs through peer reviewed publications in the area of educational scholarship. In 2017, after she assisted in the establishment of the innovative Practice Based Clerkship, she performed a study that evaluated the students’ expectations and their experiences in this immersive course.

These findings helped her to not only improve the course, but also led her to publish the results in a peer reviewed journal (Journal of Veterinary Medical Education).

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Dr. Wendy Mandese shown with a patient in UF's Small Animal Hospital.

Photo courtesy of Nick Burchell.

“Dr. Mandese is an integral part of the veterinary curriculum at UF, providing hands on experience in an area that becomes the primary area of practice for the vast majority of our graduates,” Dr. Christopher A. Adin, chair of the small animal clinical services department, said of Dr. Mandese. “I can think of no one more deserving of recognition in our College.”

Dr. Mandese first attended the University of Central Florida where she received her B.S. in music education (1993) and, later, her B.S. in biology (1997). She went on to receive her DVM from the University of Florida in 2002. She worked in private veterinary practice for 18 years, and, since joining the staff at UFCVM, has received numerous awards, including Core Small Animal Clinician of the Year in 2015 and 2017 and the University of Florida Superior Accomplishment Award in 2016.

FAEP MEMBER DONATES LUNCHES

TO UFCVM CLINIC STAFF When COVID-19 changed daily life and the meaning of "normal," long-time FAEP member Dr. Sally Denotta stepped up to the plate. The University of Florida Veterinary Hospitals had closed for all but emergencies. Deemed essential, faculty, house officers and staff continued to run the hospitals and care for their patients (large and small) while coming to terms with the personal effects of the virus. As it forced people to separate physically, the need for support and kindness grew.

Dr. Sally DeNotta distributing lunches to clinic staff on June 5, 2020.

Photo courtesy of Dr. Sally DeNotta.

Seeing a need for solidarity in her community, Sally DeNotta, D.V.M., Ph.D., a clinical assistant professor and UF’s equine extension veterinarian, took action. Dr. DeNotta, with the help of Chris Sanchez, D.V.M., Ph.D., the interim associate dean for clinical affairs at the UF College of Veterinary Medicine and a large animal internist, bought 40 lunches as a surprise ‘thank you’ to UF Large Animal Hospital’s staff. The lunches came from local favorites: Fresco’s Pizza & Pasta and Limerock Road Neighborhood Grill, both located in Haile Village. This effort became the first of many Dr. Denotta would help coordinate.

“Sally’s a good example of how someone comes to town and forms a bond,” Gordy Braund, the restaurants’ owner, said. “She came to us and said, ‘You need help, and the people in the large animal clinic need help, so let’s collaborate.’

This small act of kindness soon spread, resulting in other UF faculty soon buying more lunches from local restaurants for large and small animal clinic staff.

“We wanted to thank the people working so hard to keep the hospital going, while also raising awareness of the major hit our favorite restaurants and their owners were taking as a consequence of the social restrictions,” Dr. DeNotta said. “The restaurants were still selling meals as takeout, and everybody loves free food, so it seemed like a win-win.”

Dr. Sally DeNotta is shown preparing to distribute lunches from a local Gainesville restaurant to large animal hospital staff on June 5, 2020. The lunches were purchased by UF faculty members to thank staff for their hard work. This effort was the latest of several DeNotta helped coordinate to show support for staff who have kept the hospital running during the pandemic.

Photo courtesy of Sarah Carey.

Adapted from a April 24, 2020 article written

by Sarah Carey and published by UFCVM.

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Farewell to Past President ~ Dr. Michael Epperson ~

FVMA: Tell us about your experience as president of the FVMA.

Dr. Epperson: Well, I will say that it was a busy year, but it was a good year. I got to know a lot of people, see a lot of things and understand how the association runs, not only on a state level but on a national level. I was able to grow as a professional and serve this great association.

FVMA: What were some of the challenges you faced?

Despite his busy schedule, the FVMA was recently able to catch up with the 92nd FVMA president, Dr. Michael Epperson, who stepped down from his role as president in March.

Dr. Epperson will continue to serve on the association’s board of governors, executive board and as the FVMA Foundation president though March 2021. Previously, Dr. Epperson served as the FVMA District VIII representative (serving northwest Florida).

He is also active locally as a member of the Miracle Strip Veterinary Medical Society, a group of veterinarians in District VIII who meet monthly to discuss the latest advances in veterinary medicine. Dr. Epperson is a twotime alumnus of Mississippi State University, where he received his bachelor’s degree in animal and dairy science and, later, graduated from the MSU College of Veterinary Medicine. His special veterinary interests include dermatology, surgery and ultrasound. He and his wife, Dr. Heather Hartley, have owned Companion Animal Hospital & Boarding Center in Fort Walton Beach, Florida since 2008 and acquired Destin Animal Clinic in Destin, Florida in 2018.

They are a dedicated team focused on high-quality care, while embracing a strong doctor-patient-client relationship. Their philosophy is to treat each pet like their own and provide the best care and medical treatment possible.

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Dr. Epperson: Most of it is the amount of time you must dedicate to this. There is always something changing every month, scheduled or not scheduled, that you are going to have to react to, whether by a phone call or through being present. Things are ever-changing. Something happening in South Florida may be completely different than what is happening in north Florida.

Our state is vast; it is really challenging to cover it all.

FVMA: What do you look back on that makes you smile?

Dr. Epperson: I felt like I gave back, not only to the profession but to future veterinarians. We were able to create a legacy of giving back. The momentum of the association continues to provide programs and protection for veterinarians. We are the voice of veterinarians in the state of Florida. One of the things I felt I got back the most was a sense of giving.

FVMA: What are some issues facing the veterinary profession

right now?

Dr. Epperson: Income-to-debt ratio is an issue. We’re working on ways to help improve that. Mental wellness is now at the forefront and more people are speaking out about it. These are problems that are not going to get resolved in a year or two.

They’re going to require a lot of dedication year after year, but we’re talking about these things more and more people are reaching out for help. That is one of the biggest changes I have witnessed over the last year.

FVMA: Why should more veterinarians and others in the

veterinary profession consider becoming FVMA members?

Dr. Epperson: These days an association may be considered an older thought. There is so much information out there and for many professionals, “they don’t know what they don’t know.” This association brings us together; it helps us support each other and this profession in a variety of ways.

FVMA: What would you say to but livestock, aquaria and, even, the food somebody who has not become more involved but wants to?

Dr. Epperson: I would say just give it a chance. Come and join us! One of the most eye-opening experiences for me was Legislative Action Days in Tallahassee. To be present, to work on veterinary issues and to see members of congress respect the profession; it will provide you with a sense of being, of making things better.

Please come and join us!

FVMA: Look 15 years down the line.

supply. We’re a very integral part of the community and we will continue to be relevant for years to come.

FVMA: Any advice you have for future

incoming presidents?

Dr. Epperson: Listen to the executive director and his vision and just keep that momentum going. What others have built before us, we continue to grow and grow.

We are going to hopefully give a generation of giving back to this profession.

In 2035, are we envisioning a strong veterinary profession or are there issues that need to be addressed?

Dr. Epperson: There are always going to be issues, but we are very important in the day-to-day lives of not only pets

Dr. Michael Epperson and his wife, Dr. Heather Hartley.

LIFE AS A VETERINARIAN FVMA: What made you want to become

a veterinarian?

Dr. Epperson: It was my first job, and it is going to be my last job. I love it. I am it.

We own two practices in our community.

It’s one of the ways that I feel like you can help people through their animals. It is super enjoyable to see the look on that person’s face when an animal responds to what you’re doing. There’s no better feeling in the world.

FVMA: Tell us about your history in the

veterinary profession and what you have done to get you to where you are today.

Dr. Epperson: I am a Mississippi State graduate. My father was in the military, so we moved around a lot. My wife and I met in Pensacola. She was finishing

her last year of veterinary school. We got married about a year after graduation.

We both love what we do. It’s easy to go to work every day. We’re passionate and dedicated to what we do. We give back in our community. We participate in associations. We want to leave our mark on the profession.

FVMA: At what point did you finally

feel comfortable with what you are doing every day as a veterinarian?

Dr. Epperson: Well, I do not know if you ever truly feel comfortable. You go in every day doing the best that you can. I always tell my clients: “I don’t know everything, but I will find someone who does.” If you work hard, and they know you work hard, and they appreciate that hard work and

effort you give, then you will always be fine.

FVMA: Any advice to recent graduates

who aren’t that confident yet?

Dr. Epperson: Surround yourself with good people. Surround yourself with likeminded people who are willing to help you. If you fall, they are willing to pick you up. Help build that confidence. I see a lot of veterinary students that come out that just lack confidence. Their skill set is there, they just lack the confidence to always implement it. I think as older veterinarians [we] should recognize that. Realize we can impact one life at a time and make a huge difference, not in only the profession but also in that person’s life.

CONFERENCES HOSTED BY THE FVMA FVMA: Why should more people attend

FVMA conferences?

Dr. Epperson: I feel like our education is second to none. Our wet labs are second to none. We’re supported by the industry.

I think their needs as far as continuing education are going to be met at our association meetings.

FVMA: Do you have a favorite moment

from past conferences?

Dr. Epperson: Once I am [at a conference], I feel like I’m surrounded by family. I truly love every minute and I don’t have one moment that stands out above the others.

Dr. Mary Smart (left), Dr. Michael Epperson (center) and Mr. Philip Hinkle (right).

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MEET THE PRESIDENT MARY SMART, DVM

FVMA President | 2020-2021

A Conversation with

FVMA President Dr. Mary Smart Westbay Animal Hospital | Bradenton, FL

Dr. Mary Smart was installed as the 93rd President of the FVMA on Friday, March 13, 2020, at the Annual Awards Ceremony & Installation of Officers during the 91st FVMA Annual Conference. Dr. Smart previously served on the FVMA Board, most recently as president-elect. Prior, Dr. Smart served five years as the District VII representative on the board. District VII encompasses the following counties in southwest Florida: Charlotte, DeSoto, Hardee, Lee, Manatee and Sarasota.

The new FVMA president attended the University of Maryland from 1976 to 1980, where she received her B.S. in animal science. She continued her education at UFCVM, where she earned her DVM in 1985. Dr. Smart has worked in both large and small animal practice as an associate veterinarian, a relief veterinarian, an emergency medicine practitioner and a practice owner in southwest Florida.

She is currently employed at Westbay Animal Hospital in Bradenton, Florida.

Dr. Smart is a past president of the Manatee County Veterinary Medical Society and is also a member of the AVMA. She has a soft spot for dachshunds and has two of her own (Ray and Lily) in addition to a horse named Chief. Outside of work, Dr. Smart enjoys boating, bicycling, and spending time with her family and with her daughter at the barn.

The FVMA was lucky enough to catch up with Dr. Smart as she took the presidential helm.

Dr. Mary Smart at the FVMA 2020 Annual Awards Ceremony with her daughter, Ellie, and two sisters, Leslie and Janice.

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Goals and Objectives FVMA: Talk to us about prior roles

that have helped prepare you to serve as FVMA president.

President: I have been on the board of directors as the District VII representative. It’s a big learning curve, but it’s been six years that I’ve been on the board and my understanding of the FVMA has grown and evolved.

FVMA: What made you ready for this

challenge as FVMA president?

President: When I took the board member position for the district, I did it to give back locally, but the more time you spend on the board, the more you want to give back to the FVMA, because it’s such an incredible association. And so, I thought, it was my turn to give back.

FVMA: What were some of your

favorite experiences when you think about your past involvement with the FVMA? President: It has really been amazing to learn exactly what [the FVMA does], how much it does and how passionate everyone involved with it is. The FVMA cares about our profession. It has been wonderful to learn all of the behindthe-scenes information about our association.

FVMA: What are some issues within

the veterinary profession that we need to address?

President: With young veterinarians, there are some significant concerns revolving around income-to-debt ratio, primarily how they are going to pay back their student loans. There are growing concerns about mental and financial wellness for veterinarians. I think the FVMA has many things in place that hopefully will work towards improving all of these issues; we have some great plans that will move us forward and help out [veterinary professionals].

FVMA: How will we get more

professionals to become members of the FVMA? President: I do feel like the FVMA is the best kept secret, which is a problem when you want to be an association with members. You need to not be a secret.

We need to promote ourselves more so that people know what we do. I think the more we are out there—advocating for them and for the profession, helping to set up continuing education, helping to promote mental and financial wellness for everyone—it will help the association and help membership.

FVMA: How can we convince members

to get more involved?

President: I would tell people that [being involved] is doable. It is a little intimidating because there is a learning curve. People are a little shy to become involved, but it is definitely doable. You go in to serve, but you end up taking away 100 times more than what you give in service. It is absolutely about personal growth, not just a professional opportunity.

FVMA: What changes are you hoping

to see within the veterinary profession during the next 15 years?

President: I hope we can, as an association, reach out to more people.

We need to let people know that we are here to help and have a huge litany of services we can offer them. We can continue to help the profession as it changes. There are a lot of differences in the profession now compared to when I graduated in 1985. As an association, we hope to evolve to fit all these new needs.

Practicing as a Veterinarian FVMA: What made you want to become a veterinarian?

President: I was one of those little kids that wanted to become a veterinarian from the time I was five.

FVMA: What did you do to prepare to be a veterinarian?

President: I went to the University of Maryland originally, and

then came to Florida to go to veterinary school. I started out in mixed animal practice and then opened my own business. I have done emergency work, relief work and shelter work. It is an amazing profession with a lot of options. It is an amazing journey.

Dr. Mary Smart examining a patient.

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FVMA: What milestones in your veterinary career do you look back on fondly?

President: I remember going out on my first farm calls right out of school

and driving the [vet] truck and when I opened my own office. Also, I remember getting to that point where I finally felt like “I got it” as a veterinarian. It wasn’t just feeling like I could handle things medically, but that I could also handle the people, helping them and doing it in the most effective way.

FVMA: How long did it take you before you felt like you got it?

President: Well, I did more large animal when I first got out [of college], so

with the horses, it took a few years for sure. It takes a while. With the small animals it took longer because I didn’t do as much with them at first, so I felt maybe five years into it I got it. Things take time.

FVMA: Any advice you have for recent veterinary graduates?

President: Take a breath every day. Give yourself breaks for making mistakes.

Mistakes will happen; we have all made mistakes. We do our best every single day. Find a good mentor or mentors. That is what made me the veterinarian I am today: amazing mentorship.

Dr. Mary Smart (center), her daughter, Ellie (left), an IHSA team member, McKenzie (right) and Dr. Smart's horse, Chief.

Balancing a Busy Schedule FVMA: Tell us about your family, do you have any pets at home?

President: One husband, one daughter, one son, one daughterin-law, three grandkids, two dachshunds, two cats and a horse.

FVMA: Favorite place to go on vacation?

President: Anywhere that my family is. I do not see them much, so we like to go places where we see each other.

FVMA: A good book you have read lately?

President: "Bend Don't Break" by Ping Fu. It was about a lady that created the computer program for Invisalign.

FVMA: A movie you could watch repeatedly?

President: "My Favorite Martian."

FVMA: A quote you try to live by?

President: “Happiness is a choice.”

FVMA: A fact about yourself that may surprise people?

President: I played club Rugby in college. I was the power player; I was not the runner. (laughs)

Dr. Mary Smart and her husband, Jim Denison.

FVMA: If I were not a veterinarian, I would be…?

President: Something in the animal field, service field, animal-

FVMA: A celebrity or person you admire? human helping field.

President: Mike Schaer from the University of Florida. He is more than a speaker. He was an incredible mentor all through FVMA: Do you have an all-time favorite animal? veterinary school. He made such an impression on my life.

President: I am a cat and horse person, but I love dogs too.

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HURRICANE PREPAREDNESS KIT FOR VETERINARIANS AND VETERINARY PRACTICES IN 2020 Another hurricane season has arrived. Preparing for these storms is a song and dance practiced each year. Recently, many of the hurricanes have been bigger, deadlier and more costly than those of previous years. The Atlantic Coast and the Central Florida area were spared from any major hurricane damage in 2019 when Dorian traversed just out of range. However, areas to the east, like the Bahamas, were not so lucky. At least 70 people died, along with more than 200 animals on multiple islands that were unable to swim in the deadly floods.

During uncertain times, it is important to remain prepared for, not scared of, what lies ahead. Your clients choose to bring animals into their homes, and these animals cannot fend for themselves when huge storms approach. The following tools will help pet owners and veterinary practices prepare for major storms.

ADVICE TO PASS ALONG TO YOUR CLIENTS

While many clients will have previously weathered hurricanes with their pets, some may be first-time pet owners or may have just moved to an area with hurricanes. Remind your clients that pets should be kept inside during the storm and indoor accommodations made for them to ‘go potty.’ It is also important to make sure the client knows that if they choose to evacuate, the pet should go with them. If it’s not safe for the pet owner, it’s not safe for their pets. As hurricanes approach, and chaos ensues, consider emailing your clients with the following recommendations.

KEEP YOUR PET IN DISASTER-READY CONDITION

• Ensure all of your pets’ collars and tags have up-to-date contact information.

▶ Microchipping a pet is one of the best ways to find them again should they become lost.

• Have proper equipment for pets to ride in the car with you (this is especially important for cats or exotics, who may not leave your house often).

• Pet carriers are needed at many shelters and can serve as a safe space for a nervous pet. They are highly recommended when transporting your pet. The pet carrier should be the correct size (the pet should be able to stand, turn around and lay down comfortably). Be sure to label the carrier with your pet's name, breed, sex, date of birth, your current address and contact numbers, and any important medical information.

• Collar or harness with ID tag, rabies tag and a leash.

▶ Carry at least one slip leash. A simple slip-type webbing or nylon leash will ensure you have a way to restrain a dog (or even a cat) in the event they slip out of their collar or harness.

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WHAT TO INCLUDE IN YOUR PET'S DISASTER KIT • At least three days to two weeks’ worth of food and water specifically for your pet stored in sealed containers.

▶ If your pet’s regular diet includes canned food, remember to have a manual can opener with you.

▶ Don’t forget bowls to serve your pet’s meals • At least two weeks’ worth of any medication they require in a sealed, airtight container.

• Important documents such as any registration information, adoption papers and vaccination documents. Photocopied records of your rabies certificate, vaccinations and medical summaries should be stored in a waterproof container.

• A first aid kit particularly for your pet. May include bandage rolls, tape and scissors; antibiotic ointment; flea and tick prevention; latex gloves, isopropyl alcohol and saline solution. A pet first aid reference book is a good idea too.

• Hygiene and grooming supplies. Any sanitation items and products you need to clean and clean up after your pet.

Consider pet litter and litter box if appropriate, newspapers, paper towels, plastic trash bags and household chlorine bleach.

• A picture of you and your pet together will help you document ownership and allow others to assist you in the event you become separated. If it is a printed photo, consider noting the pet's species, breed, age, sex, color and distinguishing characteristics on the back of the photo.

• Familiar items, such as treats, toys and bedding can help reduce stress for your pet. Toys will also help keep your pet occupied.

ASK, DON’T ASSUME

Be sure to secure accommodations for your pet before the storm.

Every time a hurricane approaches, false information circulates on social media. A common myth is that there are laws requiring all hotels to allow pets in their rooms during an evacuation notice. This statement is not true and can put you in a tough spot if all other pet-friendly hotels in your area are already booked.

Ask ahead of time if the location you plan to evacuate to is comfortable with every pet you will be bringing when you arrive there. There are also plenty of websites where you can verify if a hotel or shelter will be pet-friendly.

For more information, visit CDC.gov and search “Pet Safety in Emergencies.”

HAVE A PLAN

FOR YOUR PRACTICE Whether you plan to evacuate or ride out the storm, every effective disaster plan for veterinary practices and clinics consists of seven basic parts. All seven of these will be critical to the success of your company during a major storm.

• Emergency relocation of boarded and hospitalized animals • Backups of medical records • Continuity of operations • Building and personnel security • Fire prevention • Chemical spill prevention • Insurance coverage/legal issues Be sure to hand out your completed hurricane plan in advance, so you aren’t trying to create and disseminate a plan at the last minute.

EMERGENCY RELOCATION OF BOARDED & HOSPITALIZED ANIMALS

• Make sure leashes, carriers and other species-specific supplies are brought along.

• Plan for appropriate, pre-arranged animal transportation along with a temporary animal holding location. ▶ Include a 24-hour client contact list, which can also be accessed off-site.

• Inform staff, clients and legal counsel of your planning processes for these animals.

FIRE PREVENTION

• Identify any/all fire hazards in the workplace.

• Go over proper handling and storage procedures with the rest of the staff.

• Appoint employees who will be responsible for maintaining this equipment.

CHEMICAL SPILL PREVENTION

• Create a plan to address appropriate responses to all foreseeable emergencies, which may include hazardous chemical spills.

▶ Employees will need to be trained on the proper equipment required to respond to these issues, should they arise.

▶ Each Florida county’s extension service has information on how to respond to chemical disasters, which was provided by the University of Florida’s Institute of Food and Agricultural Services (UF/IFAS).

MEDICAL RECORD BACKUP

• Keep medical records and digital copies of important documents backed up on an off-site computer.

CONTINUITY OF OPERATIONS

• Have alternative power sources to avoid issues, should the power go out for an extended period of time.

▶ If you purchase backup generators, make sure staff is well-versed in the maintenance and operation of them.

• Compile a seven-day supply of food and water for staff and patients, along with any medications that might be needed for this seven-day period.

• Write down a list of contacts that can be used throughout the duration of the emergency operations period, should any challenges arise.

INSURANCE COVERAGE & LEGAL ISSUES

BUILDING & PERSONNEL SECURITY

Your local fire department is a great resource for inspections and evacuation drills. Each municipality has specific instructions in the event of an impending disaster.

• Outline all preferred means of reporting emergencies, as well as the main point of contact in such emergencies.

• Establish an office phone tree and pre-plan opportunities for conference calls with anyone who will be off-site during the storm.

• Secure your practice to prevent any crime, such as theft and looting WWW.FVMA.ORG |

• Make sure your insurance is up to date. ▶ Speak to your agent ahead of time, preferably before the impending disaster. ▶ AVMA PLIT’s insurance carriers accept claims from uninsured customers in affected areas. ▶ If you are insured through AVMA PLIT and you need to file a claim, you can find filing information at avmaplit.com. This site also offers additional resources to assist with commercial damage assessments, reestablishing security after a natural disaster, and minimizing interruptions for your business. AVMA LIFE will sometimes extend the grace period for premium payments for an additional 60 days following a natural disaster. If you are insured through AVMA LIFE and have questions or need assistance, call 800.621.6360 or visit avmalife.org.

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Post-disaster Resources FOUNDATION

ASSISTANCE FROM THE FVMA FOUNDATION Any FVMA member who assists in rescue, relief and recovery efforts during a natural disaster is encouraged to apply for reimbursement through the FVMA Foundation.

Member veterinarians who provide emergency boarding to animals may also be eligible. Any members who are facing an unreimbursed loss as a result of a storm may also be considered for FVMA grant assistance. For more information, contact the FVMA at 800.992.3862 or visit www.fvma.org/disaster-relief.

ADDITIONAL GRANT & REIMBURSEMENT ASSISTANCE AVMA member veterinarians participating in rescue and emergency care related to a natural disaster may apply for reimbursement through their charity, the American Veterinary Medical Foundation (AVMF). For more information visit www.avmf.org and search “disaster reimbursement grants.”

for taxpayers who have a business in, or live in, disaster areas. If you receive a late filing or late payment penalty notice from the IRS, call the telephone number on the notice in order to abate the penalty. The IRS will also waive any usual fees and expedite requests for copies of previously filed tax returns for those who were affected.

Affected taxpayers in a federally declared disaster area also have the option of claiming disaster-related casualty losses on their federal income tax return. You may also deduct personal property losses that were not previously covered by insurance or other reimbursements.

BUSINESS RELOCATION REMINDER If your practice suffers damage from a storm and you need to relocate, contact the Florida Department of Business and Professional Regulation to apply for a new establishment license for the new location. For more details, visit the Florida DBPR website at www.myfloridalicense.com.

Veterinaryloans.com Matching Veterinarians wi th Lenders

FEMA AID Those impacted by damage from these disasters can also apply for FEMA aid. There are specific loan programs for businesses and private non-profit organizations, as well as homeowners and renters in affected counties. To learn more, visit www.fema.gov or www.disasterassistance.gov.

The IRS offers tax relief to areas designated by FEMA as qualifying for either individual or public assistance. The IRS has a declaration permitting a postponement of certain deadlines

14 | FVMA ADVOCATE

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W E L C O M E T o T h e

Class o

P R o F E S S i o n

of 2020

Califf Enterprises (352) 339-0387

FVMA AWARDS DESERVING UFCVM GRADUATES WITH PRESTIGIOUS SCHOLARSHIPS The FVMA presented three scholarship awards during the University of Florida College of Veterinary Medicine’s virtual commencement ceremony, which streamed the afternoon of May 23, 2020. While the awards are traditionally presented in person, this year, due to COVID-19, FVMA President Dr. Mary Smart congratulated the 2020 graduating class and welcomed them into the profession via video. Slides acknowledging the award recipients were shown during the commencement ceremony.

Drs. Chelsie Marie Price and Tyler Powers were presented with the FVMA Foundation Scholarship, and Drs. Sloane Garcia Hoblick and Caroline Rose Reckelhoff were presented with the Charlie Bild Clinical Proficiency Award Scholarship. FVMA Foundation scholars are senior students selected for their exceptional academic achievements and who also possess outstanding leadership and communication skills. Each recipient received a $1,500 scholarship and was mailed a plaque from the FVMA Foundation. The Charlie Bild Clinical Proficiency Award Scholarship is named in honor of the late Charles Everett Bild, who was known internationally for his clinical research of cancer and cardiovascular disease. The selected recipients are senior students who demonstrate outstanding clinical proficiency with both large and small animals. They were each given a $500 scholarship and mailed a plaque.

FVMA FOUNDATION SCHOLARSHIP AWARDEES

Chelsie Marie Price, DVM

Tyler Powers, DVM

CHARLIE BILD CLINICAL PROFICIENCY AWARD SCHOLARSHIP AWARDEES

FAEP SCHOLARSHIP AWARDEE

Sloane Garcia Hoblick, DVM

Caroline Rose Reckelhoff, DVM

The FAEP Scholarship Award was presented to Dr. Sarah Randell, who will pursue a career in equine medicine post-graduation. The selected recipient demonstrates high ethical standards, solid communication and a strong desire to serve horses and people. Dr. Randell received a $1,000 scholarship and was mailed a plaque.

Sarah Randell, DVM

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Processing W orry : HOW DO WE WORK THROUGH IT?

Philip Richmond, DVM, CAPP, CCFP, CRT What is worry? Worry is defined as a chain of negative thoughts, about the same or different topics, which may have negative consequences for you in the future. Often a solution is not reached, and the same thoughts return. It is difficult to reverse this behavior when we are thinking in this manner.

The thoughts engage you mentally, expend a great deal of psychological energy, and are disturbing and intensive.1 The thinking process begins as “something bad is going to happen.”

These thoughts often present themselves as questions: “What if ____ happens?” or “I’ll never ___.” Worrying is, in actuality, an evolutionary adaptation. It allowed our ancestors to assess future threats. Thoughts of these impending threats lead to feelings of anxiety. The resultant actions from feelings of anxiety are: 1) stimulation of the sympathetic nervous system (fight or flight response) and 2) the desire to run away or separate ourselves from the threat. Anticipation, and the following anxiety, of a tiger waiting to jump out and devour us is certainly beneficial. This is why easy-going ancestors didn’t fare as well in the ol’ tiger scenario as the worrier did. Thanks to the theory of natural selection, guess whose genes we inherited?

We believe that worrying about the future can prevent harm by enabling us to perform better through problem solving. While

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strategic planning is effective, this is not what we are doing by worrying. Catastrophizing and runaway-train thinking create a condition that our body and brain perceive as a threat.

The stimulation of our sympathetic nervous system narrows our focus and impedes our cognitive performance. It is the exact opposite of what we think we are accomplishing. Now, worry was beneficial to our ancestors because a tiger is an acute, life-threatening situation. In the chronic, overutilized way we experience worry today, it hinders our progress toward well-being.

When our brains worry, we cannot differentiate thought from what is happening in real time. The brain does not know the difference between what it sees and what it thinks about. During a study in 2000, “Imagery neurons in the human brain,” Drs. Kreiman, Koch and Fried discovered that there is an 88% overlap in parts of the brain that are stimulated by direct observation versus recalling and imagining an event.2 This is why our heart rates will skyrocket during a suspenseful scene in a horror movie.

We can picture in our minds what is about to happen.

Worrying makes us more likely to make an emotional rather than a rational decision. The prefrontal cortex is responsible for rational, logical decision making. When worrying engages the sympathetic nervous system, the limbic system — or “lizard brain” — takes control. It hijacks control from the prefrontal cortex and sets the stage for emotional, impulsive decisions.

Worrying thoughts lead to worst-case scenario or catastrophic thinking. Another apt term is snowball thinking. These are thoughts built on top of each other, making each one particularly stronger than the one before it. They make irrational worries feel more rational than they actually are. Have you ever had the thought—whether accurate or not—of, “oh no, I’ve messed up this case?” The thought leads to “I’m going to get fired and brought up before the board.”

Following almost right on top, “if I lose my job, I’ll never get another in this economy.” Then, here comes “no job, no place to live—my dogs and cats will have to go up for

PROBLEM SOLVING

Our worries are most often irrational. According to a recent Statistic Brain Research Institute survey, 60% of things worried about will never happen and 90% of the things feared were considered to be insignificant issues. A 2013 study commissioned

by UK health and well-being corporation, Benenden Health, found the average respondent worried for 14.3 hours a week— that’s 744 hours a year or 1,885 days/5.2 years of worry in a lifetime. These results are similar to what has been observed in the US. The survey showed the most common subject of worry was being overweight. Finances, health and mortality slid in the top 5. Given our current COVID situation, the subjects listed would likely be similar if the survey was done today.

adoption and I will be living in my car.” The details may be different but most of us have fallen for that sort of catastrophic thinking at some point in our lives. If we try to relate the first thought (the mistake) to the last thought (living in my car with no pets) there is zero causation or correlation (more on this later). However, our brain makes these little hops in logic that, at a passing glance, seem reasonable. This is why we fall for the results from worry in the first place.

In a 1995 paper, Drs. Michael Scheier and Michael Bridges stated: “Being aware of one's problems and concerns is healthy and adaptive as long as being aware leads to either productive problem solving or rapid disengagement.”3 The issue lies with our belief that worry is problem solving. We need to find a way to separate the emotion from the problem solving itself.

How do we re-engage our powerful and rational prefrontal cortex and stiff-arm our emotion-driven limbic system?

1

There are three effective ways for us to combat worry that integrate the principles of calming and focusing. In her 2006 book, Feel the Fear and Do It Anyway, Dr. Susan Jeffers offers the first tool.4 She directs us to look back on challenges we have previously overcome in our lives. We can say to ourselves, whatever is in front of us, “I’ll handle it.” Remembering our past adversities, we can tell ourselves: “I handled it then, I’ll handle this now.”

This isn’t supposition; this is fact. She suggests we don’t fear the things we think we fear. Our real fear lies with our belief that, whatever it is, we may not be able to handle it.4 If we don’t move forward, it leads to a self-fulfilling prophecy. When we don’t act out of fear, it makes us believe we couldn’t handle it in the first place. This serves to worsen the problem.

2

The second option is confronting and challenging the concern. We can ask ourselves: is there any action we can take right now, or as soon as we are physically able, to affect the matter in our head? If the answer is yes, take action.

Just take the very first step, we don’t need to solve the entire issue all at once. Allow yourself to then let go of the emotion surrounding it. If the answer is no, accept that you cannot act and acknowledge that further energy expended is energy wasted and let the emotion go. Of course, this is a skill that takes practice. However, this is incredibly important for veterinary professionals. How many of us get home after a long day and begin worrying about a patient from earlier that day? Everyone raised their hands, right? We suffer from a belief that excessive worry somehow equates to caring. This isn’t true, but it’s ok. We came by it honestly. Often, we learned about worry from our first role models—our parents. Many times, they had an unhealthy relationship with worry and for the same reason: errant thoughts running through our heads create a snowball effect. Often, they lead to a visualization of the worst-case scenario. This does not lend itself to a serene and peaceful experience. Again, be gentle with worry. When we become more aware of these worry thoughts (bless their heart, they think they are trying to protect us), we may feel frustrated that we have them in the first place, but worry is only trying to protect us. In the past, it saved us from tigers and so it is the reason our ancestors survived. Now, we do not have tigers trying to devour us through texting, emailing, asking questions about work or any of the other things that tend to get us going. So, how can we turn this tanker full of worry around once it is in motion?

3

The third tool we can use is a management tool called a threepoint estimation. We can separate outcomes into “worst case, best case, most likely.” This works as a cognitive tool in positive psychology that enables our mind to visualize how unlikely our worries are. The first step is to identify the adversity itself and then the resultant catastrophic cascade.

Next, begin to list each step of the scenario. Now, continue this progressive process until the last event that feels like the absolute

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In a 1995 paper, Drs. Michael Scheier and Michael Bridges stated:

"Being aware of one's problems and concerns is healthy and adaptive as long as being aware leads to either productive problem solving or rapid disengagement.”

worst-case scenario. Once all the progressions are listed, apply a percentage likelihood of each happening based on the adversity itself. For example, your manager asked to speak to you after work (the adversity). What is your initial worry?

“She wants to talk to me about the case with Mrs. Smith.”

Ask yourself, on a scale of 0-100%, how likely is it that your manager will speak to you about a specific case? Maybe.

Let us say there is a 30% chance. Are you going to get fired over a misunderstanding with Mrs. Smith? This is extremely unlikely—0%. Your brain might have followed up the idea of getting fired with the loss of your license to practice, which may have snowballed into a loss of your livelihood and the need to give up your pets. The likelihood of this is also 0% too.

When we break down our worry snowball, we can visualize how irrational our worries can be.

Let us run the exercise to the other end of the spectrum. Only full throttle best-case thinking is allowed here.

The manager calls you into the office to tell you your client satisfaction score is through the roof. You are getting a high six-figure salary. With your new income, you pay off your student loans. You become a sought-after national speaker asked to share your secret. Andy Roark calls you for advice.

After you hang up with him, Oprah (because you are now BFFs) texts you to host her new show on pets. You become an advocate for all things good with no haters on social media. Your message brings the world together—well done.

This exercise serves two purposes. First, we can see the bestcase scenarios our brain can come up with are just as unlikely as the worst cases. Second, we get a boost of positive emotion connecting these. Positive emotions are shown to cause our thoughts to broaden. We become more creative and are prepared for the big picture thinking involved in the next step of “worst case, best case, most likely.”

Seeing how unlikely both scenarios are, our rational brain can now engage and give us the most likely course of events. The actual path usually lies somewhere between worst and best case.

Most times, we can create an action plan based on the mostlikely scenario. Going through this tool with a mental health professional, a coach or a trusted friend can increase its efficacy.

Our worry thoughts are meant to alert us to an actual, current problem. They are not meant to assess innumerable events during a workday as vital threats, resulting in our fight or flight system being chronically switched on. Learning and practicing how to calm and focus ourselves and our thoughts can lead to greater peace and serenity. These tools help us to problem solve efficiently, making us better veterinary professionals. As far as the

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associated emotion that comes with worry, we can now channel our inner Elsa with these tools and “let it go, let it go…”

References 1. Borkovec, T.D., Robinson E., Pruzinsky, T., DePree, J. “Preliminary exploration of worry: Some characteristics and processes,” Behaviour Research and Therapy, Volume 21 - Issue 1, 1983. p. 9-16.

2. Kreiman, G., Koch, C., Fried, I. “Imagery neurons in the human brain.” Nature 408, p. 357–361, 2000.

3. Scheier, M., Bridges, M. W. “Person Variables and Health: Personality Predispositions and Acute Psychological States as Shared Determinants for Disease,” Psychosomatic Medicine: May/June 1995, Volume 57 - Issue 3, p. 255-268.

4. Jeffers, S. Feel the Fear and Do It Anyway. Ballantine Books; 20th Anniversary edition, 2006.

Philip Richmond, DVM, CAPP, CCFP, CRT Dr. Richmond is a graduate of the University of Florida College of Veterinary Medicine (UFCVM) and practices in New Port Richey, Florida. He currently serves as the chair of both the Florida Veterinary Medical Association’s Outreach and Professional Wellness & Well-being committees. He is a member of the UFCVM well-being curriculum committee. This committee was formed with the intention to teach wellness and well-being to veterinary students and to create a model for veterinary wellness education in North America. He has also served on the board of directors of the Florida Medical Professionals Group, an organization that supports medical professionals in recovery in the state.

Dr. Richmond is a published writer and speaker and is certified in applied positive psychology. He is a certified resilience trainer, certified health coach-behavioral change specialist, certified compassion fatigue professional and a certified QPR suicide prevention gatekeeper instructor. He has earned the Penn Foundations in Positive Psychology Specialization certificate, the BerkeleyX Science of Happiness at Work professional certificate and the AVMA Workplace Wellness certificate. Dr. Richmond received an FVMA Gold Star Award for his service in 2019.

He is married to Dr. Carla Channell, who is also a veterinarian.

They have two children, three dogs (an Aussie, a Beagle/ Dachshund, and a Maltese/Affenpinscher), a bevy of cats and turtles, a sulcata tortoise, a ball python, and a corn snake.

He is a Krav Maga practitioner and enjoys weightlifting and functional training.

Practices for Sale GA: New, Coastal Savannah! 1 DVM, AAHA SA Prx, Spacious facility, Prx & RE. (GA20S) FL: New, Central Florida! SA Solo Dr Prx. 3 freestanding facilities and 6.32 acres. $900K Gross in 2019, May 2019 thru May 2020 Prx grossed > $1M. (FL12A) FL: Central. Solo dr., SA prx., $632K+ 2019 gross, RE available, in mixed commercial and residential. (FL11S) GA: South Central. $985K+ gross, up 5% in 2019, 2 dr. prx., nice facility, well-equipped. (GA14F) NC: Northeast, near VA. $1.1M+ gross, 2 dr., loyal and stable staff, attractive facility & land, Prx & RE. (NC66G) SC: Greenville & Spartanburg Area. 2+ Dr. SA prx w/RE on 4+ ac. Plus extra lot on major hwy.

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Veterinary Practice Sales, Acquisitions & Valuations

Florida Practice Listings!

Central Florida– North of Tampa– Well established, Solo Dr., $888K gross in 2019. In-house lab, digital x-ray, dental x-ray, 4400 sq., 3 exam rooms, Prx and RE available Price just reduced.

SE Coastal Fl.– Owner Financing Solo Dr. Practice 2019 gross $688, 6100 sq ft office and boarding space. Well equipped with experienced staff. Located in an upscale beach community.

Sold-S.E. Coast– Just minutes from the beach….Solo Dr. grossing ~$630K. Lease space with 4 exam rooms, very well equipped, approx. $160K in after debt income...priced to sell.

East Coast– Solo Dr. Prx with RE 2019 gross $1.07mm Very high net, well equipped, tenured staff. ~$270K in ADI. New-Equine Practice– Brevard Co.-Rare opportunity to buy a turnkey Equine practice on the central east coast. 1 to 1.5 Dr. 2019 gross $670K. Barn, stalls, treatment area, paddocks, office.

New-Eastern Panhandle– 1 Dr. w/ 2019 gross of $712K, 3200 sq. ft. clinic, 2 exam rooms, in-house lab, digital x-ray. Great small town atmosphere, only an hour for the Gulf Beaches.

New-East Orlando– 1+ Dr. Practice, grossed $535K in 2019 Very nice lease space, 2 exam rooms, in-house lab, digital x-ray.

New-North Central Fl.– 1+ Dr. 2019 gross $700K, free standing clinic w/ 2 exam rooms, in-house lab, digital x-ray, great staff Are Corporate Groups contacting you about buying your Practice?

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

VOLUSIA COUNTY: Small Animal Practice. $697K gross and $204K ADI in most recent year. Appx.

3,368 SF leased facility. [FL96] LEON COUNTY: Small Animal Practice. $744K gross and $129K ADI in most recent year. Appx.

1,978 SF facility with real estate. [FL97] VOLUSIA COUNTY: Small Animal Practice. Over $1.9M gross and $282K ADI in most recent year.

Appx. 3,086 SF facility with real estate. Seller financing available! [FL98] HILLSBOROUGH COUNTY: Small Animal Practice. $790K gross and $136K ADI in most recent year. Appx. 4,300 SF facility with real estate.

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Contact Dr. Richard Alker for further practice information.

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

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STORM AND NOISE PHOBIA IN DOGS AND CATS Lore I. Haug, DVM, MS, DACVB Fear is defined as an emotion induced by a perceived threat from someone or something. Phobia is an illogical or exaggerated fear of a stimulus. Animals with phobias show reactions that are excessive compared to the degree of danger posed by the stimulus.

Reactions to sounds can vary from mild to moderate fear, phobia or an excessive startle. Dogs in the latter category show aboveaverage reactions to noises. The dogs may recover immediately or may continue to show fearful and avoidant behavior for some time afterward. Noise phobia is a common problem in dogs, but it is not as well documented in cats. A high percentage of cats with noise phobias likely go unrecognized and untreated. Cats tend to manifest symptoms that are less bothersome to owners (e.g., hiding), while dogs manifest more active signs such as pacing, panting, destruction and escape. A 2010 survey of dog and cat owners in New Zealand, which assessed fear of fireworks, found that 46% of people indicated firework phobia in their dog or cat.

Cats exhibited mostly cowering and hiding, whereas dogs showed more active responses.1 Animals with noise phobia may show comorbid diagnoses with other anxiety-related behaviors, such as separation-related distress or generalized anxiety.

Noise fears and phobias pose a serious welfare issue for the owner and the animal. Animals with noise phobias frequently engage in behavior that results in self-harm (e.g., damage to paws and teeth during escape attempts) or destruction to the owner’s property. Owners also experience distress while watching their animals engage in heart-wrenching, panicked reactions. Owners themselves can become classically conditioned to be anxious during noise events due to their pets’ reactions.

being struck by lightning or being trapped in a home all day while the house alarm goes off. Dogs that have suffered through home invasions or first responders breaking into the home to assist an unresponsive family member, may develop phobic reactions to noises that were associated with these events. Genetics play a significant role in the phobias of humans as certain specific categories of phobias (e.g. blood/injection phobias) tend to run in families.

There is also suggestive evidence that noise phobias in dogs may be more common in certain breeds or types of breeds.2,3 Animals may develop fear of noises or phobias at any age and several studies indicate that noise phobias worsen as the animal ages. A study conducted in 2015 by Norwegian professors Linn Mari Storengen and Frode Lingaas showed a 3.4% increase in fear of loud noises with each year of age. This is also supported by clinical experience.

Phobic reactions may show a relatively acute escalation during geriatric years that may be due to age-related changes. Additionally, there are a variety of medical conditions that may contribute to the presentation of fearful behavior. The most common of these conditions include hyperadrenocorticism, hypothyroidism, cognitive dysfunction, pain conditions and sensory changes.

Medications, such as glucocorticoids, phenylpropanolamin and oclacitinib, may worsen or trigger behavior changes.

Diagnosis

A thorough physical exam and a laboratory follow-up should be done on each patient. This is particularly important in

Noise phobias tend to fall in one of several common categories.

The most common category includes percussive sounds: thunder, gunshots, firecrackers, backfiring cars, nail guns, etc. The second category includes beeping sounds, including low battery alarms on smoke detectors, cell phone sounds and house alarms. Traffic noise or appliances (coffeemakers, dishwashers, computer printers, etc.) form third and fourth categories. Less commonly, animals may develop phobias to other random sounds such as singing or cawing birds.

It is currently unclear why some animals develop phobias or exactly how those phobias develop. Nevertheless, genetic and environmental factors play a role. Some individuals develop phobias due to a previous traumatic experience, such as the house

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Relaxation training.

Photo courtesy of Dr. Lore Haug.

middle-aged to older pets and pets with treatment plans involving daily pharmacological intervention.

Diagnosis of thunder, gunshot or firework phobia in dogs is generally straightforward – most owners have observed the behavior. Dogs or cats with more uncommon phobic reactions may be harder to diagnose, as the behavior may occur in the owner’s absence or sporadically enough that the owner is unclear as to the cause of the panic reaction. It will be helpful to have the owner keep a calendar or journal of the behavior, detailing when and where it occurs. Videotaping the pet when it is alone and/ or installing security cameras to capture events that occur in or around the home may be enlightening.

It is important to lay out a complete list of all behavior that is problematic to the owner and the animal. In many instances, the animal is suffering from a behavior problem that the owner does not feel is cause for concern. Since each of these stressors contribute to the animal’s overall diminished welfare, it is important that they are all adequately addressed. A phenomenon routinely discussed in the dog behavior world, and understood but less commonly discussed from a human perspective, is trigger or stress stacking. When subjected to stressful events, an animal may be able to cope with each event individually, but when those stressors combine, it leads to an untenable situation. This leads to decompensation and an overt reaction such as a panic attack. This is seen in animals that are anxious or aggressive who then become painful for some unrelated reason. The painful condition lowers their threshold to cope with the behavioral stimulus, resulting in a more frequent or heightened reaction. It is important for the clinician to identify each stressor in the animal’s environment and eliminate, or address, as many as possible.

Treatment

In line with Susan Friedman’s Humane Hierarchy of Behavior Change Procedures, the clinician must first address the animal’s physiologic status. This includes medical care, nutrition, exercise and enrichment. Although exercise will not cure a behavior problem, a lack of exercise and enrichment is an environmental stressor to the animal and, as noted above, can exacerbate symptoms from other stressors. Drs. Katriina Tiira and Hannes Lohi found that dogs with separation anxiety and noise phobia had less daily exercise compared to those that did not have these conditions.4 It is also important to ensure the animal is receiving adequate social contact.

The next most important intervention is antecedent arrangement: attempting to prevent the expression of the behavior by avoiding exposure to the problematic stimulus. Clearly with storms this is often impossible; however, as almost all noise-phobic animals are more distressed when they are home alone, owners should try to avoid leaving the pet home alone during storms. Options include pet sitters, friends, or neighbors; day boarding at a local vet clinic or daycare; or owners working from home on those

Destruction and self-injury from panic during a storm.

Photo courtesy of Dr. Lore Haug.

days, if possible. Animals with traffic noise phobia should be walked away from roads and highways. Confine the animal away from problematic appliances. Animals that are afraid of fireworks can sometimes be boarded in soundproof facilities or facilities in areas where fireworks are banned. Play competing background noises (TV, radio, white noise maker) to diminish the salience of the problematic noise. Some animals also benefit from listening to classical music or specific soothing sound mixes, such as Through A Dog’s Ear™.

Establish a safe zone for the pet within the home. Ideally, this should be an interior room or cubbyhole away from external windows or walls. If the safe zone is along the exterior structure of the home, look for an area with few or no windows. Bathrooms or large walk-in closets often work well. Other locations may be closets under a stairwell, spaces under a desk, open crates or home-made tents the owners construct in an appropriate location.

More importantly, the area should be a location where the dog or cat may already be inclined to go when he or she is frightened.

This area will be used during relaxation and counterconditioning training, so the process will proceed more quickly and smoothly if the animal is already comfortable with or drawn to the location.

Teaching the pet even a small suite of behaviors will facilitate relaxation training but also provide constructive ways to help

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trigger emotional shifts in the distressed animal. Common behaviors include “sit,” “down,” nose (hand) targeting and mat relaxation. Behaviors trained with positive reinforcement develop a classically conditioned association with the reinforcer used during the training. For example, dogs trained to “shake” using treats generally do this behavior vigorously and eagerly. The dogs are “happy” to perform the behavior and doing so makes them happy. These behaviors can be used to help shift a fearful pet into a more positive state. This emotional shift will only occur if the behaviors are trained using positive reinforcement.

Often, owners ignore well-behaved pets and pay attention when the animal is misbehaving or exhibiting distressed behavior. Dr. Arnja Dale and her colleagues found that dogs and cats whose owners comforted them when they displayed a fearful response during noise events showed an increased severity and duration of fear.1 It’s important to counsel owners on how to recognize and reinforce calm, relaxed behavior routinely throughout the day. Our initial, working definition for “calm” that we teach owners includes the pet being quiet and having all four of its feet stationary on the ground. This means a pet that is sitting, standing or lying quietly. We also counsel owners to routinely reinforce pets that are playing with toys or chewing on bones, as these are also reinforcement-worthy behaviors. The pet should be reinforced at least 20-30 times per day for good behavior, both randomly (when the owner is not directly interacting with the pet) and when the owner is attempting to interact with the pet (e.g., training, greeting, leashing for walks, feeding time, etc.).

Relaxation training starts during low distraction times (i.e., in the absence of a noise event), ideally, in the pet’s safe zone. There are a number of protocols for teaching and shaping relaxation depending on the skill and patience of the owner and the arousal level of the pet. The clinician should choose the process that seems most appropriate for that individual case. Aromatherapy, massage and TTouch® can often facilitate relaxation training.

Desensitization and counterconditioning sessions are quite useful and effective for reproducible noises such as appliances, cell phone sounds and even fireworks. Some animals will show some level of fearful response to audio files of these noises and this makes counterconditioning more effective as the volume and duration of the noise can easily be manipulated according to the pet’s progress. In the simplest sense, these noises should predict and be paired with highly reinforcing experiences to the pet (most commonly food or toy play). For example, a dog with a strong fetch-drive can be exposed to low-gradient noise events (e.g., fireworks) while the dog is engaged in the game. Ideally the noise stimulus should be presented first and then the game starts immediately after the animal shows orientation to the sound.

The onset of the sound should predict the game for the pet: “I hear fireworks and I get to play ball!” Once the sound source ends, the game stops. Or, if the animal ceases playing, the owner

26 | FVMA ADVOCATE

should shut off the sound source. Clearly, this type of Pavlovian conditioning works best for highly controllable sound events.

Storm-phobic dogs are far more complicated due to the unpredictable nature of storms and our inability to control the pet’s exposure. Additionally, storm-phobic animals typically develop phobic reactions to a variety of storm-associated parameters such as rain, overcast skies, wind, and changes in temperature and barometric pressure. Some pets also react to alterations in ozone or the sounds associated with power outages during storms.

Most of these are difficult to re-create or the recreations are not sufficiently realistic to trigger any apprehension in the pet.

Handling the pet’s behavior during real noise events centers on four intervention categories: distraction techniques; appropriate owner reaction; effectively utilizing preconditioned behaviors; and product and pharmacological assistance. As noted above, playing background noise or engaging the animal in distracting activities, such as play or high-value food puzzles, can control symptoms in mild to moderate cases (and help develop Pavlovian conditioning to the noise event). Activity-based distraction works best for short noise events as the animal obviously can only play or eat for a finite period.

Owners should avoid just consoling and comforting the pet.

This may make the owner feel better, but it generally does not aid the pet in the short or long-term. Rather, instruct owners to remain emotionally neutral to outbursts of fear and panic while reinforcing any decrement that the animal exhibits in such behaviors. For example, the owner should ignore a dog that jumps on them frantically during a storm, but as soon as the dog sits or lays down at the owner’s feet, the owner should praise and reinforce the dog. The owner can engage in interactions or activities that clearly produce increased relaxation and decreased anxiety in the pet. This process is greatly facilitated if the animal has preconditioned behaviors. Engaging the pet in the positively reinforced behaviors noted above can often reduce the animal’s anxiety. Similarly, if the owner has been rigorously working on the relaxation training in the pet’s safe zone, the owner should encourage the pet to go to that safe zone. Once there, the owner can continue to implement training, massage, etc. to enhance relaxation throughout the noise event.

Products such as pheromones (e.g., Adaptil® or Feliway®), Thundershirts® and Mutt Muffs can also be used during noise events. Note that the animal must be previously acclimated to the latter two before using these products during real noise events.

While distraction and behavior modification are often quite effective for mild noise phobia, animals with moderate to severe panic require pharmacological assistance. Animals may require a daily medication and/or an event (i.e., as needed) medication. Daily maintenance medications do not take effect quickly enough, nor do they adequately control intense spikes in panic. Daily medication

is most appropriate for animals that have multiple anxiety, fear or phobic diagnoses and for animals where avoidance of the problematic situation is particularly difficult. The event medication is the most essential and important aspect of the pharmacological treatment plan. No noise-phobic animal should be treated solely with a daily maintenance medication, particularly at the start of the treatment program. Drugs commonly used as event medications include trazodone, alpha-2 agonists (clonidine, Sileo® oral gel), gabapentin and benzodiazepines (e.g., alprazolam, clonazepam, lorazepam, diazepam). Acepromazine is appropriate only as an adjunct to another truly anxiolytic medication. Event medication should be based on the animal’s signalment, health status, duration of the effect, re-dosing capability and individual response. Medications can be used alone or in combination.

Owners should be encouraged to keep a log of each dosing, so the clinician can better track the animal’s response to various drugs and doses across noise events. This author attempts to achieve at least 70% improvement with an event medication protocol. If this has not been achieved within one to three noise events, then the dose and/or medications should be altered in an attempt to reach this goal.

References 1. Dale, A. R., Walker, J. K., Farnworth, M. J., Morrissey, S. V., & Waran, N. K. (2010). A survey of owners’ perceptions of fear of fireworks in a sample of dogs and cats in New Zealand. New Zealand Veterinary Journal, 58(6), 286–291. https://doi.org/10.1080/00480169.2010.69403.

2. Blackwell, E. J., Bradshaw, J. W. S., & Casey, R. A. (2013).

Fear responses to noises in domestic dogs: Prevalence, risk factors and co-occurrence with other fear related behaviour. Applied Animal Behaviour Science, 145(1–2), 15–25. https://doi.org/10.1016/j.applanim.2012.12.004.

3. Storengen, L. M., & Lingaas, F. (2015). Noise sensitivity in 17 dog breeds: Prevalence, breed risk and correlation with fear in other situations. Applied Animal Behaviour Science, 171, 152–160. https://doi.org/10.1016/j. applanim.2015.08.020.

4. Tiira, K., & Lohi, H. (2015). Early life experiences and exercise associate with canine anxieties. PLoS ONE, 10(11), 1–16. https://doi.org/10.1371/journal. pone.0141907.

Event Medications for Dogs and Cats DOGS

CATS

Acepromazine

0.25 – 1.0 mg/kg PO

0.25 -1 mg/kg PO

Alprazolam

0.04 - 0.1 mg/kg q4-12 hrs

0.12 – 0.25 mg/cat q12-24 hrs

Diazepam

0.1 – 2.0 mg/kg q4-12 hrs

1-2 mg/cat q12-24 hrs

Clorazepate

0.025 – 1.0 mg/kg q6-12 hrs 0.02 – 0.5 mg/kg q12-24 hrs

Buprenorphine

0.01-0.03 mg/kg q6-12 hrs

0.01 mg/kg q6-12hrs

Butorphanol

0.2 mg/kg q4-6 hrs

0.2 mg/kg q4-6hrs

Propranolol

5-40 mg/dog q12-24 hrs

Trazodone

1-5 mg/kg q12-24 hrs

25-75 mg/cat q 12-24 hrs

Clonidine

0.01-0.05 mg/kg q 8hrs

0.01-0.05 mg/kg q12 hours

Sileo gel

1-2 times Label instructions

Gabapentin

20-50 mg/kg q 8 hrs

100 mg/cat

Lore I. Haug, DVM, MS, DACVB Dr. Lore Haug graduated summa cum laude from Texas A&M College of Veterinary Medicine in 1993. She did a one-year rotating internship at the Louisiana State University School of Veterinary Medicine before returning to Houston in a general practice. Dr. Haug worked in general medicine and emergency medicine until 1999, when she returned to Texas A&M to complete a residency and master’s degree in behavioral medicine. After her residency, she remained on faculty at Texas A&M, running the Animal Behavior Service until 2007. She then returned to the Houston area to work in a private referral practice doing exclusively behavioral medicine.

Dr. Haug currently sees behavior cases at Texas Veterinary Behavior Services in Sugar Land, Texas.

She is a past president of the American College of Veterinary Behaviorists, a member of the American Veterinary Medical Association, a certified animal behavior consultant through the International Association of Animal Behavior Consultants, and a member of the Association of Professional Dog Trainers and the American Veterinary Society of Animal Behavior. Dr. Haug has a special interest in neurobiology, learning principles and pharmacology.

Dr. Haug is a frequent speaker at veterinary and behavior conferences. She also writes for a number of industry publications. She is an active equestrian and shares her home with her husband, a pit bull-mix dog and an Arabian gelding.

Practice Pulse QUESTION: I have a form requesting medical information

regarding my patient from a doctor of chiropractic who is also certified by the American Veterinary Chiropractic Association to adjust animals. The form states that I am referring this patient to her for treatment. How do I respond and is she legally able to treat this dog?

A: A chiropractor cannot adjust an animal under their license. If a chiropractor associates with a veterinarian, the chiropractor can treat an animal under the veterinarian’s authority. It is a properly delegable task that can be done under responsible supervision of the veterinarian. Issues of responsibility and risk must be handled between the parties. The veterinarian must ensure they or the chiropractor has the proper insurance to handle the amount of risk that may be associated with treatment. There is a large disparity of risk if the treatment is for a million-dollar racehorse as opposed to a companion animal. The veterinarian’s license is “on the line” if they delegate to a person that is not qualified by licensure, training or experience.

We've reproduced the Rule in the Florida Administrative Code below, which applies in this case.

61G18-19.002 Complementary or Alternative Veterinary Medicine.

(1) Definition – Complementary, alternative and integrative therapies means a heterogenous group of preventive, diagnostic and therapeutic philosophies and practices, which at the time they are performed may differ from current scientific knowledge, or whose theoretical basis and techniques may diverge from veterinary medicine routinely taught in accredited veterinary medical colleges, or both. These therapies include, but are not limited to, veterinary acupuncture, acutherapy and acupressure, veterinary homeopathy, veterinary manual or manipulative therapy (i.e., therapies based on techniques practiced in osteopathy, chiropractic medicine, or physical medicine and therapy); veterinary nutraceutical therapy and veterinary physiotherapy.

(2) Communication of treatment alternatives – A licensed veterinarian who offers to provide a patient with complementary or alternative health care treatment must inform the owner of the patient of the nature of the treatment and must explain the benefits and risks associated with the treatment to the extent necessary for the owner to make an informed and prudent decision regarding such treatment option. In compliance with this subsection: (a) The licensed veterinarian must inform the owner of his or her education, experience and credentials in relation to veterinary complementary or alternative health care treatment option. (b) The licensed veterinarian may, in his or her discretion, communicate the information orally or in written form directly to the owner or to the owner’s legal representative.

28 | FVMA ADVOCATE

(c) The licensed veterinarian may, in his or her discretion and without restriction, recommend any mode of treatment that is, in his or her judgment, in the best interests of the patient, including complementary or alternative health care treatments, in accordance with the provisions of his or her license.

(3) Records – Every licensed veterinarian providing a patient with a complementary or alternative health care treatment must indicate in the patient’s record the method by which the requirements of subsection (2) were met.

(4) Effect – This section does not modify or change the scope of practice of any licensed veterinarian, nor does it alter in any way the provisions of Chapter 474, F.S., which require licensees to practice within standards of care, and which prohibit fraud and exploitation of clients.

QUESTION: I am a practicing veterinarian in Vero Beach, Florida, and my pharmacy has just told me that, according to a law passed in January of this year, all prescriptions after July 1st are to be electronic only. They will no longer accept written scripts, emails or faxes.

Do you have a recommendation on a company that we should use?

A: This law does not apply to veterinarians. It only applies to “health

care practitioners” as defined in F.S. 456 (DOH). Veterinarians are governed under F.S. 474 which is not included in the 456.001 Definitions (4) F.S.

QUESTION: I'm currently a licensed veterinarian in Florida and recently spoke with another vet who claimed that in the state of Florida the VCPR is specific to the veterinarian and not to the clinic. That is to say, for example, if a veterinarian has not personally examined a patient, but the patient has been seen regularly and within the last 12 months by another veterinarian employed at the same clinic, it would be unlawful for the veterinarian who has not seen the patient to authorize prescription refills or prescribe new medications. Is this correct?

A: The VCPR is with the veterinarian, not with the clinic. Nevertheless,

a VCPR can be established if the veterinarian has sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian is personally acquainted with the keeping and caring of the animal and has recently seen the animal or has made medically appropriate and timely visits to the premises where the animal is kept, and • Is available or provides follow-up care and treatment in the case of adverse reactions or failure of the therapy regimen.

• Maintains records documenting patient visits, diagnosis, treatment and other relevant information required under this chapter.

GOT A QUESTION? THE FVMA CAN HELP.

One of the benefits of an FVMA membership is our helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-6 p.m. Our helpline also provides insight to the FVMA staff of the challenges and concerns of our members. In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.

This is a situation that depends on specific facts and professional judgment. In the case of a patient of the clinic, the veterinarian can acquire sufficient knowledge of the animal by reviewing the records.

They are available to provide follow-up care and will maintain records by updating the existing record. The second veterinarian may not have recently seen the animal or perhaps may have seen it at the clinic previously. This part is intended for agricultural animals because of the mention of medically appropriate visits to the premises where the animal is kept.

So, in the case of authorizing a refill, there is a much stronger case than with new medication for a new condition that may require specific testing or physical examination to diagnose. At the end of the day, the veterinarian is supposed to take care of the patient. In human medicine, a physician on call in the same situation is authorized to prescribe. It is understood that the on-call physician is not taking over treatment but just assisting the physician of record. The same must be true in the veterinary setting.

QUESTION: I have a question regarding the telemedicine guidelines. My doctor is doing telemedicine consults as she is at high risk during the pandemic. Regarding the guidelines for telemedicine, can the client just have a VCPR with the hospital or does the VCPR need to be with that specific doctor performing telemedicine?

A: This depends a lot on what the telemedicine consultation is

about. If the veterinarian has access to the patient records from the clinic and she is dealing with something that would not require a fullblown physical examination, then perhaps. If the client brings the animal to the clinic and someone performs a physical exam, then the vet could use those results to guide her professional judgment.

QUESTION: Can a VCPR be extended by a telemedicine visit?

In other words, if I see a previously established patient via telemedicine today, and their VCPR was originally set to expire on June 1, 2020, is that date the new anniversary of the VCPR? A: Referring to the disciplinary guidelines, Rule 61G18-30.001(1)(y)3., F.A.C., which contains a definition of the documented VCPR:

The documented patient/client/veterinarian relationship cited in section 474.214, F.S. is herein defined as a veterinarian’s record of a client’s animal which documents that the veterinarian has seen the animal in a professional capacity within a period of 12 months or less.

So, and for the purpose of prescribing medication, the 12 month time would be required. Examining the patient via telemedicine meets the requirement of “seeing the animal in a professional capacity,” so as long as the animal is seen within one year from the date of the last visit, either in person or via telemedicine, the VCPR remains intact.

QUESTION: Can you clarify if, as a sole practitioner, I do not need to renew my HCCE permit IF I order Rx medications under my personal name instead of my LLC? A: As a sole practitioner you can do both and you do not need an

HCCE. If you order drugs under your company however, we advise that you provide a letter to your wholesaler which confirms your status as a sole practitioner operating business as a professional service corporation or limited liability company.

QUESTION: Do amendments for 61G18-16.002 Continuing Education Requirements for Active Status License Renewal, which became effective April 4, 2020, require business and wellness courses in biennial CE for licensure?

A: They do not require hours in either one of those subjects. They

LIMIT the number of hours to no more than 5 hours in either subject.

END NOTE: The ultimate responsibility

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

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MVS Pet Care FL is currently looking for Veterinarians to help us meet the demands of our growing client base in Miami/Ft. Lauderdale and West Palm Beach.

In this unique, exciting role, you will visit and serve your patients in the comfort of their pet family home. You will build and nurture long-term pet-family relationships by focusing on quality visits over quantity. You will work in a lower stress environment, resulting in a better quality of life.

At MVS Pet Care FL we provide: • Competitive salaries with built-in profit and revenue sharing • Comprehensive training on treating patients in the “at-home” environment • Support from our Veterinary team to assist with scheduling, patient follow-up, and patient referrals • Continuous learning opportunities and sharing best practices with Veterinarians in the national MVS network • CE Allowance • Flexible, non-emergency schedule • Company vehicle • Health benefits (Medical, Dental, Vision, Life) • Wellness programs • 401(k) with company matching • Generous vacation days and PTO

30 | FVMA ADVOCATE

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If you have a disability under the Americans with Disabilities Act or similar law, or you require a religious accommodation, and you wish to discuss potential accommodations related to applying for employment at our company, please contact HR@Chewy.com.

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