Advocate Issue 4, 2021 by FVMA

ADVOCATE ISSUE 4 | 2021

THE FVMA’S REBRAND what our changes mean for you - Page 5

CALL FOR 2022 FVMA AWARD NOMINATIONS

submit your nominations - Page 15

UPCOMING EVENTS 2021-22 mark your calendars - Page 18

FVMA LEGISLATIVE ADVOCACY

in partnership with Converge Government Affairs - Page 26

207 Monetary Drive 7 Orlando, Florida 32809 Phone – 407.851.3862 Toll-free – 800.992.3862 Fax – 407.240.3710 info@fvma.org www.fvma.org

OFFICERS

Dr. Richard Sutliff President Dr. Marta P. Lista President-elect Dr. Donald H. Morgan Treasurer Dr. Mary Smart Past President

DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Thomas E. Hester District 2–Northeast Dr. Todd Fulton District 3–Central Dr. Donald S. Howell District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Robert L. Swinger District 6–South Florida Dr. Barbara Lewis District 7–Southwest Dr. John R. Wight District 8–Northwest

President's Message The FVMA has been involved with so many exciting activities these past months that it is difficult to know where to start. We put on an excellent in-person FVMA Annual Conference, experienced office leadership changes, launched the Power of 10, hosted AVMA leadership, and so much more… As for the rest, I don’t know where to start, so I am going to skip straight to where I need to finish. Our colleagues and our profession are currently under extreme duress. The stresses involved with our most amazing occupation are tearing some of us asunder. We are the most trusted group of professionals in the world, and now, we have the highest suicide rate of that same group. This association exists for a simple and singular purpose: to serve our membership! With increased stressors from social media, increased debt, increased time needs for family and other forces chipping away at veterinarians' self-esteem, the FVMA Foundation has elected to fully fund and pay for the help our members need. At the bottom of this page is a QR code for you to scan with your phone camera. This link will take you to download the app for our Membership Assistance Program (MAP). Do this now, and it is my sincere hope you never need to use in the event of an emergency. It is my largest fear that you may need to use it at a critical time and not already have it downloaded and ready to use at that important moment. You can read about the many benefits this program provides later on our website, in our emails, and more... but, for right now, scan the code and download the app so you know where it can be accessed. We are in this together, and again, we are here to provide the services our members need. Respectfully Yours

Dr. Christine M. Storts District 9–Space Coast Dr. Ernest C. Godfrey AVMA Delegate

Richard Sutliff, DVM

Dr. Richard B. Williams AVMA Alternate Delegate Dr. Jacqueline S. Shellow FAEP Representative to the FVMA Executive Board Dr. Dana Nicole Zimmel Dean, Ex Officio

FVMA MISSION:

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

Opinions and statements expressed in the FVMA 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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Thank you FOR BEING A VALUED MEMBER Your membership entitles you to a new benefit known as the Member Assistance Program (MAP). There is no enrollment or payment required to utilize this service. We have partnered with McLaughlin Young Group, an independent provider of MAP/EAP services. The MAP offers help for personal and/or professional concerns by providing free, confidential, short-term counseling and personal consultation. Additionally, the MAP provides work-life resources for such issues as legal and financial consultations, online learning, and resources. They also host a variety of helpful seminars. MAP ALSO HAS A NETWORK OF COUNSELORS that are conveniently located. They can help you improve or resolve personal difficulties whether big or small, personal or work-related. Some examples of concerns that the MAP addresses include: • • • •

Family conflict and relationship issues Depression and anxiety Resiliency and coping skills Work-related issues

TAKE ADVANTAGE OF THIS WONDERFUL BENEFIT TODAY! DOWNLOAD THE MYGROUP APP TO GET STARTED.

• • • •

Grief and loss Alcohol or drug use Stress Legal and financial issues

CONFIDENTIALITY IS ONE OF THE MOST IMPORTANT FEATURES of the MAP. No one will know that you have used this resource, unless you offer that information or unless someone’s safety is threatened. THERE IS NO COST TO YOU FOR YOUR PHONE CALLS OR FACE-TO-FACE VISITS WITH THE MAP. The FVMA covers all expenses for this program. You are eligible to use the MAP immediately. To seek assistance through the MAP, simply call 704-529-1428 or 800-633-3353. Your call is important - see how the counseling process works. Visit mygroup.com | Click on My Portal Login | Work-Life | Username: fvma2021 | Password: guest The MAP staff at McLaughlin Young is available 24 hours a day, seven days a week, ready to assist you. Appointments are available during daytime and evening hours. The MAP is not designed to evaluate fitness for duty or authorize leave of absences but will provide referrals as needed. www.fvma.org

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In Remembrance Gary Shelton, DVM Gary R. Shelton, DVM, passed away suddenly at his home in Elkton, Florida, on June 20, 2021, surrounded by his loving wife, Nena, and his two carefree Jack Russell Terriers. Dr. Shelton, age 63, was himself a carefree and happy-go-lucky person, was a well-known local veterinarian. Born and raised in Bethesda, Maryland, he moved to Florida and graduated from the University of Florida College of Veterinary Medicine. His career began in Interlachen, Florida, where his exceptional professional skills, pleasing personality, infectious laugh and business acumen launched the successful Shelton Veterinary Clinics located in Interlachen, Elkton, Bunnell and Palm Coast, Florida. Always available for animals in need, he was a great comfort for the owners too, who knew they were in competent hands.

In addition to his clinical practices, Dr. Shelton volunteered at the Flagler Humane Society, where he was previously a medical director. He also volunteered internationally, traveling numerous times to Thailand with his wife to provide desperately needed care. Dr. Shelton also enjoyed traveling, biking, scuba diving and spending time with all, but he especially treasured playing with his grandchildren. Dr. Shelton is survived by his wife, Nongnard Shelton; brothers, L. Robert Shelton III, Richard (Beth) Shelton DDS; mother, Elizabeth Shelton; niece and nephew, Jessi and Ryan; stepdaughter, Opal Kersawat; and grandchildren; Athena and Arya. He was proceeded in death by his daughter, April Shelton, and his father, LaVega Robert Shelton, Jr.

IN THIS ISSUE 3 4 5 6 8

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New Member Benefits In Remembrance FVMA Rebranding Member Spotlight Introduction to Small Animal Point-of-care Ultrasound 15 | FVMA 2022 Award Nominations Open 16 | FVMA 2022 General Elections 4 | FVMA Advocate

NOTICE SOMETHING DIFFERENT ABOUT US?

We’ve rebranded!

THE STORY BEHIND OUR REBRANDING The FVMA Advocate’s new look is a result of our association’s rebrand — a revitalization of our goals and

commitment to you!

More than just a facelift, we’ll be serving you in more

supportive and engaging ways than ever before! Our

devotion to veterinary medicine is almost a century old, and from the very start, we were made to protect and serve the veterinarians of this great state. Our noble founders, some of whom also helped institute the Florida Board of Veterinary Medicine, wanted to form an association that would elevate and defend veterinarians and the practice of veterinary medicine in Florida.

Knowledge and education have been at the core of our mission since our inception–but one of the most

important things you can learn is when to change. We knew it was necessary to modernize our look and our offerings, not only help to sustain the veterinary profession, but to evolve in ways that will flourish in an ever-changing future. That’s why, over the past few years, we’ve been working behind the scenes to bring you an improved association. In short, we envision

an FVMA that can go further, support you more and ultimately, give your compassion a voice. This new look is a part of that commitment. Our rebrand is deeper than a fresh logo, redesigned publications and new visuals. We are devoted to helping you excel in your career and flourish as a person. Thus, we introduced a host of new

membership benefits, including MAP (a mental wellness program), a Florida relief veterinarian list, complimentary legal consultation, our Power of 10 leadership program, and even more discounts and reduced rate services. These are just a small sample of how the FVMA is evolving to support you. Our new website makes navigating all aspects of what we offer easier than ever, and our renewed focus on content creation will give you more ways to engage with your profession. Ever since our founding, we’ve been growing and evolving for you. In the 1940s, we had 200 members. After World War II, an increase in veterinary schools across the U.S. sparked a rise in FVMA membership, and we steadily grew to 600 in 1986.

Today, we stand nearly 6,000 members strong-making us the third largest veterinary medical association in the U.S.

Though this extended brand rollout is just the beginning of what the FVMA will offer for years to come, many of our new offerings are already available–with more coming soon! We hope you will continue to remain engaged and excited for the future of veterinary medicine. Our responsibility is to

ensure your profession is situated for the best possible future-and that future is brightest when you are a part of it.

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Images courtesy of FVMA

MEMBER SPOTLIGHT: Dr. Trevor Zachariah DVM, MS, Dipl. ACZM

From the tiniest beach mouse to the mightiest giraffe, the Brevard Zoo is home to a world-class veterinary staff dedicated to ensuring the physical health of every animal in their care. The team is led by board-certified veterinarian Dr. Trevor Zachariah, who oversees the Harris Animal Care Center, Sea Turtle Healing Center and animal commissary. As the medical director of the Brevard Zoo, FVMA member Dr. Zachariah oversees the care of 732 animals that represent more than 180 species from Florida, South America, Africa, Asia and Australia. Growing up in Coldwater, Michigan, Dr. Zachariah chose to pursue a career in zoo veterinary medicine as a child and never wavered in what he wanted to do. When asked if he loves what he does, Dr. Zachariah never hesitates to answer “Yes.” “Zoo and wildlife medicine keeps things interesting,” he says. “No two days are the same, so monotony and boredom are rare. It is also extremely challenging with hundreds of species under our care and relatively little clinical knowledge available about any of them.” Of the many species he looks after, he is particularly fond of invertebrates (namely spiders), which he notes aren’t covered extensively in veterinary school. Often students only learn about a 6 | FVMA Advocate

few species of invertebrates, mainly because they are parasites or disease vectors. While those can be the main attributes of some species, Dr. Zachariah notes that’s a narrow way of looking at them. “Invertebrates are fascinating,” he says. “There are millions of species, and they are all so different from the vertebrates that are our typical patients. There is a huge dearth of research in diseases, diagnostics and treatments.” Dr. Zachariah earned his bachelor’s degree in zoology and his DVM from Michigan State University. He is also an alumnus of Louisiana State University, where he participated in an exotic pet and wildlife medicine internship and received his master’s degree in veterinary clinical sciences. He completed his Zoological and Aquatic Animal Residency through the University of Illinois, Brookfield Zoo, Lincoln Park Zoo, and the John G. Shedd Aquarium. He has served as the Brevard Zoo’s veterinarian since 2010 and achieved board certification as a diplomate of the American College of Zoological Medicine in 2013. Dr. Zachariah is one of two veterinarians in Brevard County board-certified by the American College of Zoological Medicine. He has served as director of the zoo’s Sea Turtle Healing Center since its inception in 2014.

Dr. Zachariah performs a routine preventive health exam on a flamingo.

Image courtesy of Brevard Zoo.

Debridement of a superficial skin lesion on a ridley sea turtle.

Image courtesy of Brevard Zoo.

“To get into zoo and wildlife medicine, you have to work hard, be persistent and plan for sacrifice,” he says when asked about advice he might have for others interested in a similar career path. “The field is small, so opportunities are limited and competitive. Often, you have to make opportunities for yourself, and they will likely come at the expense of your time, finances and possibly relationships. However, if it is your dream, then the sacrifices are all worth it when you achieve small goals like successfully treating an animal or larger goals, such as a job, degree or board certification.” More than just a day job, Dr. Zachariah is active in many professional organizations, including the FVMA, AVMA and AAZV. He actively participates in various activities within those organizations, such as journal peer review, conference session management and committee work.

Dr. Zachariah performs a routine preventive health exam on a parakeet.

Image courtesy of Brevard Zoo.

“Membership is great, but these organizations, and veterinary medicine at large, only get better when we give back to them with time and effort,” Dr. Zachariah says of his involvement. “Additionally, it is incredibly inspiring to be part of this community when you see what your colleagues are accomplishing by collaborating with them, reading journals and texts, and attending conferences.” Dr. Zachariah, and his fellow veterinarians at the zoo, also provide medical care for the patients at the Florida Wildlife Hospital. The rehabilitation center welcomes all wild animal species other than sea turtles and marine mammals. With his work touching so many lives and species, Dr. Zachariah must constantly adapt and learn. “Two things,” he says surprise people the most about what he does. “The first is that, though you may be specialized in the field, being a zoo veterinarian in practice is like being a general practitioner. You fill all the roles for your patients: internist, anesthesiologist, surgeon, radiologist, dentist, pharmacist, etc. There are a lot of skills involved in the job. The second is that zoo veterinarians have many roles outside of the practice of medicine. We participate in research, animal nutrition, zoonotic disease education and control, teaching, habitat design, regulatory requirements, budgeting, staff supervision, public relations, and a whole lot more. The job is almost never strictly about medicine.”

Dr. Zachariah performs a routine preventive health exam on a capybara.

Image courtesy of Brevard Zoo.

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All personnel and sea turtle rehabilitation activities at Brevard Zoo's Sea Turtle Healing Center are permitted by Florida Fish and Wildlife Conservation Commission MTP #206.

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Image courtesy of Shutterstock.

INTRODUCTION TO SMALL ANIMAL POINT-OF -CARE ULTRASOUND AND THE 5-POINT-5-MINUTE ABDOMINAL POINTOF-CARE ULTRASOUND EXAM (APOCUS) Søren Boysen, DVM, DACVECC Serge Chalhoub, DVM, DACVIM (SA) Adam Gonzales DVM, DACVIM (SA) INTRODUCTION Veterinary point-of-care ultrasound (POCUS) is defined as focused real-time ultrasonography brought to the patient, performed by the attending clinician in conjunction with initial patient assessment, to answer specific clinically driven questions (often binary) or to guide interventions. It parallels human POCUS evolution, having evolved from the original abdominal and thoracic FAST exam.1-3 Similar to human POCUS, veterinary POCUS answers a number of questions beyond a search for free fluid or pneumothorax, expanding its application to almost any patient, not just those limited to the trauma setting.⁴ The sonographic skills applied in POCUS are easily mastered by general practitioners and evidence suggests the clinical questions answered do not require extensive or advanced training.1,4,5 Although there are many aspects of POCUS, as explained below, the focus of the second half of this article will be on the 5-point-5-minute abdominal point-of-care ultrasound (APOCUS) exam. Pleura and lung ultrasound and cardiovascular ultrasound are discussed and demonstrated in the FVMA wetlab and lecture series, but due to space restrictions, will only be 8 | FVMA Advocate

discussed briefly in this article. To deepen your understanding and usage, we highly encourage you to attend a wet lab. Although the applications of POCUS are continually expanding as research evolves, and new applications are being continually evaluated (e.g., optic never sheath diameter, ultrasound-guided nerve blocks, etc.), in general, POCUS can be divided into three key systems examinations to help facilitate learning; 1) the abdomen, 2) the pleural space and lungs, and 3) the cardiovascular system. It’s important to emphasise that POCUS is situational and applied differently depending on clinical settings encountered. In general, there are four clinical settings that can be encountered which influence how POCUS is applied; 1) triage POCUS is applied as a tool to rapidly identify the most immediate life-threatening and critical conditions; 2) serial POCUS is applied to monitor progression or resolution of any pathology and response to therapy; 3) total systemic POCUS is aimed at detecting asymptomatic conditions, new developments and/or to ensure sonographically detectable problems have not arisen prior to undertaking

Figure 1: Veterinary POCUS currently involves three organ system focused examinations, 1) abdominal, 2) pleural space/lung and 3) cardiovascular, which are assessed in a holistic manner. POCUS is also situationally applied in four key clinical settings. 1) At the time of presentation, concurrent with history, triage, and other clinical findings to rapidly facilitate a diagnosis or guiding further workup by interpreting specific clinical scenarios. In this manner, POCUS is applied as a triage tool to rapidly identify the most immediate life threatening and critical conditions. 2) Serial POCUS is applied to monitor progression or resolution of any pathology, and response to therapy. 3) Systemic POCUS is aimed at detecting asymptomatic conditions, new developments and/or to ensure sonographically detectable problems have not arisen prior to inducing anesthesia, performing procedures or discharge of the patient. 4) Finally, therapeutic guided POCUS is used to reduce complications of interventions where applicable. In essence, there are five T’s of veterinary POCUS: trauma, triage, tracking, treatment and total systemic. Note: MEDB - minimum emergency database; VPOCUS - veterinary point-of-care ultrasound; ECC - emergency and critical care.

Image courtesy of Drs. Boysen and Chalhoub.

procedures, anesthesia, or discharge; and 4) therapeutic POCUS is used to reduce complications of interventions where applicable (see Figure 1). In essence, there are five T’s used to apply POCUS, which can be summarized as: trauma, triage, tracking, treatment/ therapeutic and total systemic POCUS (screening). POCUS is situationally dictated and must therefore be applied considering the specific clinical setting encountered, incorporating all history and clinical findings (Figure 1). The immediate clinical scenario and presenting complaint prioritize the order of scanning and determine if all components or only specific aspects of veterinary POCUS are appropriate. For example, if a patient presents for respiratory distress, pleura and lung POCUS is performed before abdominal POCUS. In this specific clinical scenario, the presenting complaint and initial triage exam dictates the most life-threatening clinical POCUS questions (often binary) to answer first. A full POCUS exam would delay treatment and is not immediately recommended. Furthermore, stabilization including thoracentesis takes precedence: do not compromise patient safety or delay lifesaving interventions to complete the full POCUS evaluation! Therefore, POCUS in the triage setting prioritizes a search for the most likely cause of a patient’s life-threatening problem. As each condition is assessed, the next most life-threatening clinical problem based on history, clinical findings and POCUS pre-test probability should be ruled out. A full physical exam or full veterinary POCUS examination is not immediately recommended if the patient is unstable, and time is of the essence. Similar to a triage exam being followed by a more comprehensive physical exam, once the patient is stable and life-threatening conditions have been dealt with, more comprehensive total POCUS evaluations (i.e., full PLUS and other abdominal and cardiovascular POCUS scans) can be completed.

MATERIALS AND PATIENT PREPARATION FOR POCUS

An ultrasound machine specifically dedicated for POCUS is highly recommended, particularly a portable ultrasound machine that can be transported to the cage side. Bring the machine to the patient, not the patient to the machine. A micro-convex curvilinear probe capable of B-mode is ideal for POCUS. Frequency settings typically range from 5MHz (dogs >20kg) to 7MHz (dogs and cats ≤20kg). POCUS exams typically do not require shaving patient fur. The fur can be parted and alcohol applied over the scanning site (if you can see and apply the probe directly to the skin the image quality should be good). The non-dominant hand is used to separate the fur and can be used to move the skin, allowing less alcohol to be applied. If image quality is poor due to thick undercoat (e.g. some Northern dog breeds) or if greater detail is desired, shaving fur may improve the sonographic image. Alcohol is usually the sole acoustic coupling agent. Alcohol-based hand gels can be used. Ultrasound conducting gel may be used alone or applied following the application of alcohol to enhance image quality; gel should be smoothed against the skin to prevent formation of air bubbles which can interfere with image acquisition. Patients are ideally scanned in the position they are most comfortable and which causes the least degree of stress: standing position as well as sternal or lateral (left or right) recumbency are most common. Patients scanned in lateral recumbency may be rolled into a sternal position to access non-gravity-dependent sites. Unstable patients should NEVER be placed in dorsal recumbency for POCUS, as this may cause patients to decompensate or even arrest. The order of sites scanned during each POCUS procedure is not critical, however, each clinician should develop a systematic and consistent approach and should adapt the order based on the situation encountered (Figure 1).

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Figure 2: Abdominal small animal POCUS windows with the patient in left lateral recumbency: 1) subxiphoid, 2) umbilical, 3) urinary bladder, 4) right paralumbar and 5) left paralumbar. Each location is evaluated in longitudinal and transverse planes with rocking and fanning of the probe to maximize the area evaluated and to ensure all target structures/sites are thoroughly evaluated and to decrease false positive and negative results. All five sites are evaluated in all patients regardless of patient positioning; however, the area scanned should be modified slightly depending on the pathology to rule in/rule out and in light of how patient positioning will affect where pathology accumulates. For example, if the patient is in a standing position and the goal is to detect free peritoneal fluid, the probe is placed directly on midline over the umbilical and urinary bladder regions with the ultrasound beam directed towards the spine (vs. towards the tabletop when the patient is in a lateral position). With the patient in lateral recumbency, as shown, the probe should be directed from the non-gravity-dependent side of the patient towards the gravity-dependent body wall areas where fluid is most likely to accumulate.

Figure courtesy Vivian Leung, 2020, with permission.

THE 5-POINT-5-MINUTE ABDOMINAL POCUS (APOCUS) EXAM The patient can be positioned standing, in right or left lateral recumbency, or in sternal recumbency with both hindlimbs turned toward the sonographer to allow access to the subxiphoid and bladder areas. APOCUS involves systematic evaluation of five sites in the abdomen (Figure 2). 1. Subxiphoid site: this view is obtained by placing the probe just caudal to the xiphoid process and angling the probe cranially at approximately 45 degrees (the tail of the probe tips towards the hindlimbs). Key structures evaluated include the liver lobes, the gallbladder (hypoechoic), the hepatodiaphragmatic interface (white hyperechoic curved line separating the abdominal and thoracic cavities), the heart, the pericardial space, and the pleural space (Figure 3a). The caudal vena cava (CVC) can also be visualized at this site (two hyperechoic lines traversing the diaphragm slightly to the right of midline).

Figure 3a: Subxiphoid site with the patient in right lateral recumbency demonstrating the initial probe location and angle.

Image courtesy of Drs. Boysen and Chalhoub.

2. Umbilical site: assesses the spleen intestines and most importantly the most gravity-dependent site along the body wall, which varies depending on patient positioning (standing vs. lateral) (Figure 3b). 3. Bladder site: this view is obtained by placing the probe just to the non-gravity-dependant side of midline on the caudal abdomen, just cranial to the pelvis, and angling the probe downward toward the gravity-dependent side of the patient’s body. In some patients with intra-pelvic or very small bladders, the probe may need to be moved more caudally to visualize the bladder. Target structures include the urinary bladder (particularly the apex of the bladder) and the surrounding areas.

Figure 3b: Umbilical site with the patient in right lateral recumbency demonstrating the initial probe location and angle, directed towards the tabletop (gravity-dependent regions). The probe is directed towards the spine when the patient is in a standing position.

Image courtesy of Drs. Boysen and Chalhoub. 10 | FVMA Advocate

4. Left paralumbar site: this view is obtained by placing the probe on the left flank, caudal to the last rib and just ventral to the paralumbar muscles. If the target structures are not adequately visualized from this position, the probe can be moved forward to the 12th intercostal space on the left side. Key structures to assess include the left kidney, the spleen (including the tail of the spleen), the left body wall and the surrounding areas (Figure 3c).

Figure 3c: Urinary bladder site in a patient in right lateral recumbency demonstrating the initial probe location and angle, directed towards the tabletop (gravity-dependent regions). The probe is directed towards midline when the patient is in a standing position.

Image courtesy of Drs. Boysen and Chalhoub.

Figure 3d: Left paralumbar site in a patient in right lateral recumbency demonstrating the initial probe location and angle.

5. Right paralumbar site: this view is obtained by placing the probe on the right flank, caudal to the last rib, and just ventral to the paralumbar muscles. If the target structures are not adequately visualized from this position, the probe can be moved forward to the 11th or 12th intercostal space on the right side. Target structures include the right kidney, the liver, the small intestine, the right body wall and the surrounding areas. At each APOCUS site, the probe is fanned through an angle of forty-five degrees to either side of perpendicular, in both the long and short axis planes to maximize the area evaluated and to ensure all target structures/sites are thoroughly evaluated. Image depth should be set at approximately 5 – 10cm for most APOCUS sites (depending on the size of the patient) and 10 – 15cm for the subxiphoid site. Adjust depth settings as needed to ensure optimal image quality. All five sites are evaluated in all patients regardless of patient positioning; however, the area scanned should be modified slightly depending on the pathology to rule in/rule out and in light of how patient positioning will affect where pathology accumulates. For example, if the patient is in a standing position and the goal is to detect free peritoneal fluid the probe is placed directly on midline over the umbilical and urinary bladder regions with the ultrasound beam directed towards the spine (vs. towards the tabletop when the patient is in a lateral position). With the patient in

Image courtesy of Drs. Boysen and Chalhoub.

Figure 3e: Right paralumbar site in a patient in right lateral recumbency demonstrating the initial probe location and angle. If the patient is sufficiently stable, it can be gently rolled to allow easier access to the gravity-dependent paralumbar region. Alternatively the patient can be rolled into a sternal position (Figure 3f).

Image courtesy of Drs. Boysen and Chalhoub.

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Figure 3f: Right paralumbar site in a patient in sternal recumbency demonstrating the initial probe location and angle. If the patient is less stable or cooperative, once the non-gravity-dependent sites have been evaluated the patient can be gently rolled into a sternal position to allow the gravity-dependent regions to be assessed.

Image courtesy of Drs. Boysen and Chalhoub. @thefvma

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lateral recumbency, as shown, the probe should be directed from the non-gravity-dependent side of the patient towards the gravity dependent body wall areas where fluid is most likely to accumulate. One of the primary objectives of APOCUS is to look for free fluid in the abdomen. Free fluid typically appears as black (hypoechoic) triangles in between the target structures (Figures 4a-4c). Common sites for free fluid accumulation include in between liver lobes, at the apex of the bladder, at the cranial and caudal poles of the kidneys, and in between loops of small intestine. Normal hypoechoic abdominal structures can be mistaken for free fluid; structures commonly mistaken for free fluid include the gallbladder, common bile duct, hepatic veins, caudal vena cava, and occasionally the GI wall and/or GI contents. Scanning with the probe in both longitudinal and transverse orientation and adjusting the depth of the image can improve the clinician’s ability to accurately assess the presence or absence of small volumes of free fluid during APOCUS.

Figure 4b: Key structures to assess at the left paralumbar site of APOCUS with abdominal effusion present. Note: FF - free fluid.

Image courtesy of Drs. Boysen and Chalhoub.

Abdominocentesis is recommended if free abdominal fluid is identified, particularly in non-trauma patients as the type of fluid is highly variable and cannot be determined by sonography alone. Following centesis, the type of free abdominal fluid (transudate versus modified transudate versus exudate, septic versus non-septic, hemorrhagic versus non-hemorrhagic, etc.) can be rapidly determined through cytology and/or biochemical analysis. Ultrasound-guided centesis can help prevent accidental laceration of abdominal organs and/or hollow organ aspiration (i.e. intestines, bladder). In addition to assessment for abdominal free fluid, APOCUS also allows estimation of volume status by evaluating changes

Figure 4a: Key structures to assess at the subxiphoid site of APOCUS with abdominal leffusion present. GB: gallbladder. Note: FF - free fluid.

Image courtesy of Drs. Boysen and Chalhoub.

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Figure 4c: Key structures to assess at the urinary bladder site of APOCUS with abdominal effusion present. Note: FF - free fluid.

Image courtesy of Drs. Boysen and Chalhoub.

Figure 4d: Key structures to assess at the right paralumbar site of APOCUS with no abdominal effusion.

Image courtesy of Drs. Boysen and Chalhoub.

Figure 5: The common clinically driven, often binary, questions asked and answered using the 5-point-5-minute APOCUS exam.

Image courtesy of Drs. Boysen and Chalhoub.

in the diameter of the CVC with respiration. Although studies in veterinary medicine are lacking, this technique is commonly used in human emergency medicine. The CVC can be visualized at the subxiphoid site as two hyperechoic lines traversing the diaphragm slightly to the right of midline and typically to the right of the gallbladder. Fluctuations in the diameter of the CVC of 25 – 50% between inspiration and expiration are considered normal. Respiratory fluctuations in the diameter of the CVC > 50% suggest hypovolemia. The absence of respiratory fluctuations in the diameter of the CVC (static distension) suggests increased right atrial pressure (ie. volume overload or right-sided heart failure) (Figure 3). Other APOCUS questions that are commonly answered include the detection of pneumoperitoneum, ureteral obstruction associated with ureteroliths (particularly in cats with presenting with acute azotemia), urinary bladder volume estimation, gastro-intestinal motility for detection of ileus, presence of pleural effusion and pericardial effusion via the subxiphoid site, and cardiac activity during CPR via the subxiphoid site (Figure 5). As a final note, the authors want to stress that POCUS does not, and will never, replace thorough history, clinical examination and scientific reasoning. It does, however, provide an invaluable tool for the emergency and critical care clinician as it assists with procedures and can guide and monitor treatment. Remember, the clinician should not be blinded by the benefits of POCUS and should appreciate its limitations.

References: 1. Boysen SR, Rozanski EA, Tidwell AS, et al: Evaluation of a focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents, J Am Vet Med Assoc 225(8):1198-1204, 2004. 2. Lisciandro GR, Lagutchik SM, Mann KA, et al: Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs, J Vet Emerg Crit Care 18(3):258-269, 2008. 3. Lisciandro GR, Lagutchik MS, Mann KA, et al: Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma, J Vet Emerg Crit Care 19(5):426-437, 2009. 4. McMurray J, Boysen S, Chalhoub S. Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting. J Vet Emerg Crit Care. 2016 JanFeb;26(1):64-73. 5. Beeston D, Cole L. Evaluation of the utility of point-of-care ultrasound in detecting ureteral obstruction in cats. Abstract Ultrasound J 12, 45 (2020).

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Søren Boysen, DVM, DACVECC

THEIR LOVE IS UNCONDITIONAL, AND SO IS YOUR CARE

Dr. Søren Boysen completed his DVM at the University of Saskatchewan, a small animal internship at the Atlantic Veterinary College, and a residency at Tufts University, becoming an ACVECC diplomate in 2003. He is the former chief of veterinary ECC at the University of Montreal, and currently a full professor at the University of Calgary. Although he loves all things ECC, he is considered a pioneer of veterinary pointof-care ultrasound (POCUS). With the help of many great colleagues around the world, he introduced the veterinary profession to the FAST exam, adapted AFAST and TFAST to non-trauma settings, and most recently developed the 5-point-5-minutes abdominal point-of-care ultrasound (APOCUS) and pleura and lung ultrasound (PLUS) approaches for use in small animals. Along with POCUS, his research interests include fluid resuscitation, hemorrhage, coagulation and perfusion.

Serge Chalhoub, DVM, DACVIM (SA) Dr. Chalhoub graduated from the DVM program at the faculté de médecine vétérinaire (FMV) of the Université de Montréal in 2004. Serge followed this with a one-year rotating small animal clinical internship at the same institution. After working for two years as a general practitioner and emergency veterinarian in Montreal, he pursued a residency in small animal internal medicine at the Animal Medical Center (AMC) in New York City. Once his residency completed in 2009, he stayed on at the AMC as their first renal/hemodialysis fellow and, later, as a staff doctor. Dr. Chalhoub has been a faculty member at the University of Calgary’s Faculty of Veterinary Medicine (UCVM) since 2012. He is the recipient of multiple teaching awards, including the 2015 University of Calgary Team Teacher of the Year Award with his colleague Dr. Søren Boysen. He has authored and co-authored numerous scientific articles and book chapters on veterinary point -of-care ultrasound, renal and urinary medicine, and has lectured at numerous conferences on these topics.

Adam Gonzales DVM, DACVIM (SA) Dr. Gonzales is a graduate of Colorado State University College of Veterinary Medicine and Biomedical Sciences (1999). Following veterinary school, Dr. Gonzales completed an internship in medicine / surgery at VCA West Los Angeles. He completed his residency in small animal internal medicine at Tufts University Grafton, Massachusetts (2003), and obtained board certification in 2004. He has a strong interest in ultrasound and minimally invasive procedures and is skilled in ultrasound of the thorax and abdomen and in endoscopy of the gastrointestinal tract, respiratory tract, and urinary tract.

Your clients depend on you to help guide them throughout their pet’s lives – as well as at the end of it. As a Paws & Remember provider, you benefit from our specialized staff training, quality education material, dignified cremation services, and memorial items that are tailored to the needs of the pet owner and their pet. These resources will help your clients cope with their loss and remember their beloved companions in a way that is meaningful to them. Contact us for more information about how we can help you create a more personal memory for your clients.

pawsandremember.com

14 | FVMA Advocate

Florida Keys

171 Hood Ave. #4 | Tavernier, FL | 305-699-9576

SUBMIT YOUR NOMINATIONS BY DECEMBER 3, 2021

NOMINATIONS ARE NOW OPEN FOR THE FVMA 2022 ANNUAL AWARDS

The Florida Veterinary Medical Association invites you to nominate deserving candidates for the 2022 FVMA Annual Awards! Awards in several categories will be determined by a special committee in early December 2021. Award recipients will be publicly honored at an awards presentation ceremony on March 18, 2022, during the 93rd FVMA Annual Conference in Orlando, Florida. This is an important program for our Association, giving us the opportunity to honor outstanding members and individuals who serve our profession with distinction and contribute to the advancement of veterinary medicine in the state of Florida. We invite you to participate in this valuable program to recognize peers, colleagues and friends of the profession for their achievements and contributions. FVMA Annual Awards also highlight exceptional service by Florida citizens who have dedicated their time, talent and services to the enhancement and protection of the veterinary profession. Awards include a “Citizen of the Year” and nominated pets can be inducted into the “Pet Hall of Fame” with a Pet Hero Award. Nomination forms and listings of past award recipients are available at https://fvma.org/membership/awards/. Members of the FVMA are encouraged to nominate deserving colleagues and friends of veterinary medicine for an award. Members may also call the FVMA toll-free at 800.992.3862 for assistance in nominating a deserving colleague or friend for an award. www.fvma.org

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

2022 Award Categories • • • • • • • •

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

NOMINATION DEADLINE:

DECEMBER 3, 2021 @thefvma

@the__fvma

@thefvma | 15

2022

FVMA GENERAL ELECTIONS

DR. MARY SMART, CHAIR

According to the bylaws, nominations for president-elect shall be made by a Nominating Committee composed of four FVMA District representatives and the FAEP representative (in even years) or five (in odd years) FVMA District representatives, and chaired by the immediate past president. During even numbered years, the representatives from Districts 2, 4, 6, 8 and the FAEP representative shall serve on the Committee, and during the odd numbered years, Representatives from Districts 1, 3, 5, 7 and 9 shall serve.

AVMA Alternate Delegate

2022 NOMINATING COMMITTEE MEMBERS

The following district representative seats will be open for election to the FVMA Executive Board in 2022:

• • • • • •

Dr. Mary Smart, Immediate Past President, Chairman Dr. Thomas E. Hester, District 2 Dr. Donald S. Howell, District 4 Dr. Robert Swinger, District 6 Dr. John R. Wight, District 8 Dr. Jacqueline S. Shellow, FAEP Representative

COMMITTEE CHARGE

It is the duty of the Nominating Committee to submit the names of candidates for election. All members of the Association are encouraged to suggest names of possible candidates to the Nominating Committee. Nominees for district representative to the executive board shall be submitted by the local associations located within the respective districts to the executive director at least sixty days before the annual meeting of the Association.

OPEN SEATS

The following seats will be open for election to the FVMA Executive Board in 2022:

President-elect

To be eligible for nomination as the president-elect a member must have served as an executive board member for three years and shall have been a member of the Association for at least the past five years preceding nomination.

Treasurer

To be eligible for nomination as treasurer, a member shall be a resident of the State of Florida and a member of the Association in good standing. The treasurer shall be elected for a three-year term and may be re-elected to serve one additional three-year term. 16 | FVMA Advocate

To be eligible for nomination as AVMA Alternate Delegate, a member shall be a full-time resident of the State of Florida and in good standing in the Association and the AVMA. The alternate delegate shall be elected from the full membership for a term of four years.

DISTRICT REPRESENTATIVE ON THE FVMA EXECUTIVE BOARD

District 1 Dr. Scott Richardson will have completed a second successive term and will be retiring as district representative. District 2 Dr. Thomas Hester will have completed a first term and is eligible to be elected to serve a second term. District 3 Dr. Todd Fulton will have completed a first term and is eligible to be elected to serve a second term. District 5 Dr. Susan Carastro will have completed a second successive term and will be retiring as district representative. District 6 Dr. Robert Swinger will have completed the remainder of the term of former representative Dr. Marta Lista, and will be eligible to be elected for a first term. Each district representative to the Executive Board shall be elected for a three-year term from a slate of nominees brought forward by the Nominating Committee and who reside in the given District. District representatives may be elected to two successive terms. Nominees for the 2022 FVMA election must be submitted by local associations located within the respective districts to the executive director by January 17, 2022.

DISTRICT I DISTRICT II DISTRICT VIII DISTRICT IX

FVMA DISTRICTS

DISTRICT IV

DISTRICT III DISTRICT VII

DISTRICT V

DISTRICT VI

2022 OPEN SEATS

2022 FVMA NOMINATION AND ELECTION TIMELINE The Bylaws establish a timeline for nomination deadline, as well as when the general election ballots must be mailed, tabulated and recorded. In the event there is only one nominee for a specific office, that nominee shall be considered to be elected by a unanimous vote and a ballot for that office shall not be sent to the membership. However, if there is a contested seat in any of the above open seats, the following actions and calendar are established by FVMA Bylaws:

EXECUTIVE BOARD

January 17, 2022 - Sixty (60) days prior to the annual meeting of the association, the Nominating Committee shall submit the nominee(s) for president-elect, treasurer, and alternate delegate to the executive director.

DISTRICT REPRESENTATIVES

January 17, 2022 - Nominees for district representative to the executive board shall be submitted by local VMAs within the respective districts at least sixty (60) days before the annual meeting of the association. February 1, 2022 - The executive director shall prepare a ballot listing the candidates for each office as provided by the Nominating Committee. The ballot shall be mailed to all voting members of the Association at least forty-five (45) days before the date of the annual meeting. February 16, 2022 - For ballots to be valid, they must be postmarked for return no later than thirty (30) days before the date of the annual meeting. March 3, 2022 - Fifteen (15) days before the annual meeting, a Tallying Committee, composed of two (2) active members (appointed by the president) and the executive director, shall open the envelopes and tabulate the vote. www.fvma.org

@thefvma

; President-elect ; Treasurer ; AVMA Alternate Delegate

; District 1 ; District 2 ; District 3 ; District 5 ; District 6 Send Nominations To: FVMA - 7207 Monetary Drive Orlando, FL 32809

NOMINATION DEADLINE

JANUARY 17, 2022 @the__fvma

@thefvma

FVMA & FAEP UPCOM A brand new conference just for you

IT'S NOT TOO LATE TO REGISTER

150 hours of RACE-approved quality continuing education 4 hands-on wet labs 53 hours of technician CE Florida Laws and Rules included! Dispensing Legend Drugs included!

• • • • •

SPEAKERS

Chris Adin, DVM, DACVS Darcy Adin, DVM Lenore Bacek, DVM, MS, DACVECC Sarah Beatty, DVM, DACVP Kim Bissing, DVM Megan Brashear, BS, CVT, RVT, VTS (ECC)

Angela Briggs, DVM Eric Garcia, Digital Strategist Kathy Gerken, DVM Barden Greenfield, DVM, DAVDC Kathleen Ham, DVM, MS, DACVS Ralph Harvey, DVM, MS, DACVAA Peter Helmer, DVM, DABVP Kendon Kuo, DVM, MS, DACVECC Andrew Lichtig, DVM

Tami Lind, BS, RVT, VTS(ECC) Kara Magneheim, BS Victoria Miller, DVM Gary Oswald, DVM, MS

DACVIM (Small Animal Internal Medicine) Penny Regier, DVM, MS Philip Richmond, DVM, CAPP, CRT, CCFP Denise Rollings, CVT, VTS (Dentistry) Domenico Santoro, DVM, MS, DECVD, DACVD, Ph.D, DACVM Michael Schaer, DVM, DACVIM, DACVECC Robert Swinger, DVM, DACVO Drew Winters, JD

WET LAB OFFERINGS

• Canine Extraction Techniques (Half Day)

• Ophthalmic Surgery (Full Day)

• Feline Extraction Techniques (Half Day)

• Veterinary Point-of-Care Ultrasound for Everyday Practice (Full Day)

Barden Greenfield, DVM, DAVDC Denise Rollings, CVT, VTS (Dentistry) Barden Greenfield, DVM, DAVDC Denise Rollings, CVT, VTS (Dentistry)

LOCATION

Sheraton Panama City Beach 4114 Jan Cooley Dr Panama City Beach, FL 32408

Robert Swinger, DVM, DACVO

Kendon Kuo, DVM, MS, DACVECC Lenore Bacek, DVM, MS, DACVECC

OVERFLOW HOTEL Hampton Inn Panama City Beach* 2909 Thomas Drive, Panama City Beach, FL 32408 Phone: 850-236-8988

To register, scan the QR code above, call 800.992.3862 or email meetings@fvma.org

MING EVENTS 2021-22 SCAN QR CODE TO LEARN MORE AND REGISTER THE GULF-ATLANTIC VETERINARY CONFERENCE

December 2-5, 2021 | West Palm Beach, Florida

Experience the Difference • 300 hours of RACE-approved continuing education • 11 hands-on wet labs • Maximum of 31 CE hours for veterinarians • Maximum of 20 CE hours for veterinary technicians

WET LAB OFFERINGS SURGERY • Dental Nerve Blocks, Cleaning, Probing and • Practical Techniques in Orthopedic Surgery Charting

Howard Seim III, DVM, DACVS

Robert Swinger, DVM, DACVO

ULTRASOUND • Veterinary Point-of-Care Ultrasound for Everyday Practice

• Practical Techniques in Soft Tissue Surgery • Ophthalmic Surgery

DENTISTRY • Canine Extraction Techniques

Jan Bellows, DVM, DAVDC, DABVP

Denise Rollings, AAS, CVT, VTS (Dentistry)

• Feline Extraction Techniques • Advanced Dental Surgery

• Dental Radiology Positioning and Techniques

Denise Rollings, AAS, CVT, VTS (Dentistry)

Lenore Back, DVM, MS, DACVECC

Kenneth Waller III, DVM, MS, DACVR

• Basic Small Animal Abdominal Ultrasound • Advanced Small Animal Abdominal Ultrasound

Cutting-edge CE at an Iconic South Florida Destination

LOCATION

HILTON WEST PALM BEACH 600 Okeechobee Blvd, West Palm Beach, FL 33401 P: 561.231.6000

To register, scan the QR code above, call 800.992.3862 or email meetings@fvma.org www.fvma.org

@thefvma

@the__fvma

@thefvma

FVMA & FAEP UPCOMING EVENTS 2021-22

JANUARY 21-23, 2022 HILTON OCALA

3600 SW 36th Ave, Ocala, Florida 34474

The Ocala Equine Conference offers the highest quality continuing education in equine veterinary medicine to enhance scientific and clinical knowledge for the diagnosis, treatment and care of the horse. This is an exciting opportunity for equine veterinarians to gather in “The Horse Capital of the World” for a world-class program presented by acclaimed equine medicine experts.

For Practitioners by Practitioners

2022

SAVE THE DATES

- Continued

MARCH 17-20, 2022

HILTON ORLANDO BONNET CREEK

14100 Bonnet Creek Resort Ln, Orlando, Florida 32831

Presenting more than 300 hours of stimulating, quality continuing education delivered by an outstanding seelection of distinguished speakers in an environment that enriches the entire veterinary team!

WORLD-CLASS CONTINUING EDUCATION FOR EVERY MEMBER OF THE VETERINARY TEAM! TO LEARN MORE, VISIT WWW.FVMA.ORG/CONFERENCES OR CALL 800.992.3862 20 | FVMA Advocate

CONGRATULATIONS

The 2021 FVMA Scholarship Awards THE FAEP AND THE FVMA SENIOR VETERINARY MEDICINE AWARDS ELIZABETH ANN WYMAN, DVM Recipient of: Florida Association of Equine Practitioners Scholarship INTERN | EQUINE OCALA EQUINE HOSPITAL | OCALA, FL

SAMUEL W. HOLLISTER, DVM Recipient of: Florida Veterinary Medical Association Senior Scholarship INTERN | SMALL ANIMAL ARIZONA VETERINARY EMERGENCY & CRITICAL CARE CENTER | GILBERT, AZ

SETH H. LOCKER, DVM Recipient of: Florida Veterinary Medical Association Senior Scholarship ROTATING INTERN | SMALL ANIMAL UNIVERSITY OF PENNSYLVANIA | PHILADELPHIA, PA

Accidents happen.

Learn how the AVMA Trust can shield your practice from devastating financial consequences. Employee Strains, Sprains, Trips and Slips Average Cost: $8,591

Animal Bites and Attacks

Exposure to Toxins and Chemicals

Average Cost: $1,585

Average Cost: $2,825

Is your workers’ compensation insurance provider well-versed in these common and costly accidents? Learn how insurance coverage through the AVMA Trust can meet the needs of a modern practice at avmaplit.com/WCadvantage.

2021 AWARD HONOREES

Our 2021 Annual Awards Ceremony was held July 9th at our 92nd FVMA Annual Conference.

PHILIP HINKLE – PRESIDENT'S AWARD Late FVMA Executive Director Philip Hinkle was posthumously honored with the FVMA’s 2021 President's Award (received in Hinkle's honor by Dr. Richard Williams). Hinkle served as FVMA executive director until his passing in 2020, having been with the FVMA for a total of 34 years. Hinkle was a visionary who initiated the FVMA’s rebrand and who guided the Association to be what it is today. His work at a legislative level led to many of the protections veterinary professionals enjoy today–his efforts have forever left a mark on the profession.

DR. JOHN STEVEN WOODBY – DISTINGUISHED SERVICE AWARD The 2021 Distinguished Service Award was presented to Dr. John Steven Woodby for his service to the profession. Dr. Woodby founded Calusa Crossing Animal Hospital in 1988 and has grown the practice through treating clients' veterinary needs with enthusiasm, candor and common sense. Dr. Woodby served on the South Florida Veterinary Medical Association executive board prior to becoming president in 2003. He has served on the FVMA’s Outreach Committee for more than two decades and served as chair of the committee from 2010 until 2018. Dr. Woodby has quietly and diligently worked to provide peer assistance to chemically addicted, impaired, injured or infirmed members of the profession and to connect practitioners in need to the recovery process. Dr. Woodby is a true unsung hero, and his attention to wellness among our colleagues over the years is truly appreciated.

DR. PHILIP RICHMOND – VETERINARIAN OF THE YEAR The 2021 Veterinarian of the Year Award was presented to Dr. Philip Richmond. Dr. Philip Richmond is a passionate and tireless champion for the advancement of mental health and well-being in the veterinary industry. He serves as chair of the FVMA’s Professional Wellness and Well-being Committee and the FVMA Outreach Committee. He has unwavering dedication and has been passionate about helping medical professionals in recovery for the past 10 years. He brings this valuable service to the veterinary profession while at the same time offering exemplary care to all his animal patients as a practicing veterinarian.

22 | FVMA Advocate

DR. JANET WHITLOCK – LIFETIME ACHIEVEMENT

Dr. Whitlock was the second female president of the FVMA in 2002. A service-oriented veterinarian, she is a practice owner as well as a mom.

DR. KELLY BRADY – CITIZEN OF THE YEAR Dr. Kelly Brady was honored with the Citizen of the Year Award for her outstanding contributions to the advancement of animal well-being and veterinary medicine in Florida. An experienced acupuncturist and psychotherapist, with a demonstrated history of working in the alternative medicine industry, Dr. Brady’s self-employed work is an example of what the best in the world can do. Her focus in traditional Chinese medicine places her in a unique category of her own that allows her to bridge the gap between treatment types and serve as one of the greatest in her profession, not just in Florida, but in the world.

MELISSA ENDERLE, CVT – CVT OF THE YEAR

CONGRATULATIONS

Dr. Janet Whitlock was honored with the Lifetime Achievement Award at the FVMA Annual Awards Ceremony. Dr. Whitlock started her practice in Sarasota, Florida, in 1981. Dr. Whitlock was one of the key figures who helped create the first local emergency clinic in Sarasota County, and she continued to volunteer to help steer its course despite the ups and downs of emergency practice. She turns problems into solutions with integrity and efficiency. Dr. Whitlock has helped make the Sarasota veterinary community what it is today.

Melissa Enderle, CVT, was honored as the FVMA’s 2021 Certified Veterinary Technician (CVT) of the Year. Melissa is a certified veterinary technician at Seminole Blvd Animal Hospital in Largo, Florida. During the COVID19 crisis, she did a tremendous job transitioning to lead technician. Her medical knowledge, professionalism and attention to detail allowed her to take over a variety of responsibilities, making the hiccups of curbside and back-in-office appointments as smooth as possible.

MARLA RICHMOND – TEAM MEMBER OF THE YEAR The 2021 Team Member of the Year Award was presented to Marla Richmond for being a vital member of the veterinary care team. Marla joined Animal Eye Guys in 2017 as the full-time bookkeeper. Over the past three years, Marla has been promoted to director of operations/chief financial officer and plays a key role in the management team. Lauded by colleagues for her pristine work and on-point recommendations, her “friends & family first” approach to the workplace has maintained an atmosphere of healthy well-being and comradery among the staff. In 2020, she held the position of executive director of the South Florida Veterinary Medical Association for several months.

2021 AWARD HONOREES ...CONTINUED

KARMA – PET HERO AWARD Image courtesy of Marni Bellavia

The 2021 Pet Hero Award was presented to Karma. Karma serves on the Humane Society of Brevard County’s Canines for Community Resilience Program. Karma was present upon students’ return to Parkland High School after the tragic shooting that took place in 2018. Karma served as a therapy animal to those in need after the event, understanding the gravity of the moment and bringing solace through unconditional love. Karma’s work provided a safe space for those who needed to grieve and helped make early steps toward healing.

GOLD STAR AWARDS GOLD STAR AWARDS ARE PRESENTED TO FVMA MEMBER VETERINARIANS WHO GO ABOVE AND BEYOND THE CALL OF DUTY TO CARE FOR PATIENTS. AWARD RECIPIENTS EXEMPLIFY DEDICATION AND COMPASSION IN THEIR VETERINARY PRACTICE.

2021 Gold Star Award recipients (L-R): Drs. Mario Cabrera, Robert Swinger and Robert Encinosa Not pictured: Drs. Melanie Donofro and Abigail Walls

24 | FVMA Advocate

GOLD STAR AWARD RECIPIENTS After spending five years practicing acupuncture and Chinese medicine, Dr. Melanie Donofro completed a 210-hour program on veterinary spinal manipulation therapy, a treatment style she has since worked into her practice.

DR. ROBERT SWINGER

Her primary focus in care in her own Los Robles Animal Hospital and Forget Me Not Grooming Parlor is educating animal owners on preventing pet problems before they begin.

DR. MARIO CABRERA Dr. Robert Swinger founded Animal Eye Guys at the Animal Eye Specialty Clinic. He teaches wet labs across the country and participates in his clinic’s internship and residency programs.

DR. ABIGAIL WALLS Dr. Mario Cabrera holds certifications in Veterinary Acupuncture and Tui-Na from the Chi Institute and K-Laser Therapy. A secondgeneration veterinarian, he grew his father’s practice with his unique blend of skills.

DR. ROBERT ENCINOSA Dr. Abigail Walls started working for Southeast Veterinary Oncology and Internal Medicine in 2014 as an internal medicine specialist. She also trains the local referring veterinary community through continuing education and open lines of communication for consultations over the phone and by email.

Dr. Robert Encinosa led over 70 employees at Boyette Animal Hospital during the height of COVID-19, designing a schedule for each person to ensure their safekeeping. His work during the pandemic has been a beacon of hope during a time when it was a precious resource.

CONGRATULATIONS

DR. MELANIE DONOFRO

FVMA LEGISLATIVE ADVOCACY

in partnership with Converge Government Affairs

Image courtesy of Shutterstock.

As we gear up for the upcoming legislative session beginning January 11, here's a recap of the 2021 session. This 2021 legislative session recap was prepared with the assistance of FVMA partner lobbying firm, Converge Government Affairs. The 2021 legislative session concluded April 30, 2021. Approximately 13% of the 1,839 general bills passed the Legislature, a near historical low. Pandemic-related legislation consumed much of the floor time in the final two weeks of the Legislature, foreclosing opportunities for other issues to receive a hearing. Bills related to veterinary telemedicine and animal cruelty were among those that died. Among the bills were some of particular interest to the veterinary profession. Though you will find a summary of pertinent bills below, information on additional bills can be found at: https://fvma.org/advocacy/

SB 388 Injured Police Canines - PASSED •

•

SB 650/HB 177 Tethering of Domestic Dogs and Cats - DIED •

SB 216/HB 47 Reporting Animal Cruelty - DIED •

Specifies that the failure of a veterinarian to report suspected animal cruelty is grounds for disciplinary action; requires veterinarians, veterinary technicians and other animal treatment provider employees to report cases of suspected animal cruelty to certain officials.

26 | FVMA Advocate

The bill authorizes an emergency service transport vehicle permit holder to transport a police canine injured in the line of duty to a veterinary clinic or similar facility if no person requires medical attention or transport when the canine needs it. The bill authorizes emergency medical technicians (EMTs) and paramedics to provide emergency medical care to an injured police canine at the scene of an emergency or while the canine is being transported.

A person may not tether a domestic dog or domestic cat unless the person is physically present with and attending to the dog or cat, and the dog or cat remains visible to the person at all times while tethered. A person may not tether a domestic dog or domestic cat outdoors during severe weather, including but not limited to: extreme heat or cold, thunderstorms, lightning, tornadoes, tropical storms, or hurricanes.

SB 1122/HB 731 Animal Cruelty - DIED • •

Increases qualifications needed to meet adequate shelter requirements. Expands the definition of animal cruelty.

SUPPORT THE FVMA PAC

Though we may call on the help of our membership throughout the legislative session to help advocate, contributions to the FVMA Professional Advocacy Committee (PAC) are what most significantly impact our ability to affect legislation. Our PAC is a bipartisan, nonprofit, political committee formed to raise contributions from our members and provide needed financial support for lobbying efforts. Every dollar raised for the PAC funds legislative efforts in favor of veterinary professionals, small business owners and the animals entrusted in your care. Both our lobbyists and the local and state legislators we choose to support are aligned with our values. During every Florida legislative session, the FVMA works tirelessly to ensure veterinary interests are considered as thousands of bills are introduced. In fact, FVMA professional advocacy is one of the most important benefits our association provides. Supporting our PAC helps us obtain the necessary resources to fight for your rights as veterinary professionals.

SB 1316/HB 1003 Courtroom Animal Advocates - DIED •

Contributing to your PAC is a vital part of helping us maintain successes such as these. Contributions ensure that veterinary professionals, small business owners and the animals entrusted to your care, are fought for at the legislative level. Donate today by scanning the QR code below!

DONATE TODAY DONATE TODAY DONATE TODAY

Allows a court to appoint, by its own initiative or by request, an advocate to represent the interests of an animal, whether living or dead. The court will appoint an advocate from a list provided by the Animal Law Section of The Florida Bar of designated attorneys and certified legal interns.

SB 1370/HB 911 Medical Treatment of Animals - DIED •

Provides that the same veterinary standard of care applies to services provided through veterinary telemedicine as applies to veterinary care provided during an in-person visit. Specifies that a veterinarian who establishes a veterinarian/ client/patient relationship without a physical examination may only provide the following services through veterinary telemedicine: - Triage of patients in first aid and emergency cases; or - Consultation and prescription of drugs for nutrition, training, dermatological conditions and anxiety.

WHAT COMES NEXT

Committee hearings will continue each month through December 2021, in advance of a January 11, 2022, start to the 2022 legislative session.

Every donation, even just $1, contributes to improving the lives of those in our veterinary community. As a thank you for your contribution to the FVMA PAC, you will be recognized at special events, on the FVMA website and in FVMA publications.

www.fvma.org

@thefvma

@the__fvma

@thefvma

Image courtesy of Shutterstock.

CRITICAL THINKING SKILLS Tami Lind, BS, RVT, VTS(ECC)

Every good veterinary technician needs to have some critical thinking skills to properly care for their patients. Critical thinking is defined as the ability to make a decision on the basis of thorough consideration of data discovered through investigation, analysis and evaluation. Critical thinking is not something that everyone is born with. It is a skill that must be learned, practiced and implemented in every day practice. When working with patients on the floor, situations never "follow the book." Most veterinarians and veterinary technicians love the technical aspect of the job. Placing intravenous catheters, drawing blood, placing central lines and taking radiographs are “fun,” but few veterinary professionals master physiology, pharmacology, understanding of diseases and watching for subtle changes in any patient. These skills are what set good veterinarians and veterinary technicians apart from amazing veterinarians and veterinary technicians. Integrating Critical Thinking - Nursing requires critical thinking all the time. Every veterinary professional must understand 28 | FVMA Advocate

the equipment, working parts of catheters, central lines, and how to administer medications and what they react with. Nursing also requires interpersonal skills and their development as one interacts not only with fellow nurses and technicians but also veterinarians, assistants, client services, and especially pet owners. There are multiple parts to critical thinking. These parts consist of: gathering of information or assessing a situation, focus, remembering, organizing, analyzing, generating, integrating, and evaluating. • Assess the situation through data collection. Data can be gained from many sources throughout the hospital. A veterinary technician must perform a physical exam on each patient at the beginning of their shift to gain more information about that patient. • Focus on the task at hand and remember all the facts about that patient. Try not to get two patients confused. • Organize the information that you have just received and analyze that data. Ask yourself questions about the

•

treatment of that patient. Generate and integrate some thoughts about the treatment of that patient. What nursing techniques can you use to elevate that patient’s care? Evaluate what nursing techniques worked and what did not. Is that patient improving? The nursing team is critical to all aspects of patient care and the nursing process must reflect this.

The more you go through this process, the easier it gets. Each case is an opportunity to learn. Encourage your team to go through physiology and pharmacology while rounding, then everyone can be on the same page when it comes to that patient. Encouraging Critical Thinking - In order to encourage the team to think critically, one must understand the problem and how to solve it. Questions must be encouraged. NO QUESTION IS A DUMB QUESTION! Encourage a learning environment with your team, and do not single out or embarrass a single team member. As

employees grow accustomed to these question and answer sessions, they will soon see them as an the opportunity to learn and grow in their job. A good way to help staff critically think is with rounds. Ask questions during rounds and if rounds are not occurring, then make hypothetical cases during down time. Some examples could be: What is happening in that patient that requires this medication? Why are they doing this treatment now? How does passiverange-of-motion help this patient? Should we keep blood sampling on this patient? What reacts with this medication? Most staff will be comfortable with what needs to be done for this patient, but few will understand why. No patient is going to follow the book. I encourage all veterinary professionals to ask “Why?” Medicine is complex and using critical thinking skills can help veterinary technicians understand what to do with that critical case while working with the clinician. Anticipating what the clinician and patient may need is what makes a great veterinary technician. Think: anticipating results of vital signs every time treatments are performed on a patient. Being able to troubleshoot why a result is different than two hours before is crucial to the well-being of that patient. If their blood pressure is elevated, find out why. Is it a different size blood pressure cuff? Do they need to go outside to urinate? Are they painful? Are you taking blood pressure on a different leg? Utilizing your critical thinking skills is crucial to ensuring every patient has the best chance of getting out of the ICU. Simply writing down numbers on a treatment sheet is not helping anyone, especially the patient. Veterinary technicians may not have the authority to change orders, add medications or make a diagnosis, but those limits do not mean that you should not educate yourself in all of those areas. When medical orders are made, ask yourself why? Why are we using this antibiotic over that one? Why is this patient having an arrhythmia now? Why is the blood pressure dropping in this situation, and can I do anything about it? Why are

we giving a fluid bolus now? As you learn more you will be better about anticipating these changes in the next patient that you treat, and you will be prepared. When the doctor orders that fluid bolus, you will be ready. You will know that the blood pressure is dropping and be prepared with the treatment. The most important monitoring tool in the hospital YOU. You can have the most fancy, expensive equipment, but using your senses to OBSERVE the patient is the most important. You can anticipate what is coming next. A monitor can only tell you what is happening right now. As you progress in your career, remember what has happened in the past. Collect anesthesia records and case reports of interesting diseases and experiences to help you remember them. Rely on your observations. Are the gums less pink than they were an hour ago? Do those pulses feel weaker than when the dog came in? Is that breathing pattern different? These are clues that no monitoring equipment will be able to detect. A skilled technician can never be replaced if they are using their critical thinking skills. Encourage everyone in the clinic to practice their critical thinking skills. Teaching critical thinking is vital to the job satisfaction of the staff. It teaches technicians to become proactive and not reactive. Technicians should be empowered to think critically with every patient that walks into the door. This process is something that must be built into a clinic’s culture. Information withholding, bullying, and horizontal violence are all too common in veterinary practices and spell death to critical thinking. When staff are afraid to speak up,

afraid to ask questions and afraid to make mistakes, progress cannot be made. When only one person knows how to take dental radiographs or place difficult catheters, the entire practice suffers. Critical thinking must be taught and practiced. While difficult, senior staff members must step back and allow employees to think for themselves. If a new technician or nurse is struggling with a question or technical skill, the instinct is to step in and do it for them for the sake of time. This is taking away a potential learning opportunity. If they cannot answer a question, reword it or ask another question with a similar theme to try to get them to the answer. This process takes energy and patience, but the best leaders and teachers are willing to help others grow to be their best. Fight bullying by structuring learning expectations so that everyone is involved with teaching. Reward not only the learning and progression of staff but also reward those who are teaching. Again, a culture change needs to occur and all teams need to be on board with the process and the goals. The outcome is beneficial to the team and can also contribute to the financial gain of the hospital. Engaged employees also stay longer and contribute more than just their hours in the clinic. Encourage everyone on staff to learn about their favorite disease. The more that person learns, the more everyone learns. Ask questions, participate in case rounds, attend all of the continuing education that you can. Don’t just do it “because you have to.” Use your brain. If veterinary technicians don’t learn something new everyday, they will eventually leave the practice because they get bored. Cultivate and grow your critical thinking skills, and you will be the best resource in your practice.

Tami Lind, BS, RVT, VTS (ECC) Tami Lind is the current ICU and ER supervisor at Purdue University. She has been at the university for ten years. She attended the veterinary technology school at Purdue and graduated in 2010 with her bachelor’s degree in veterinary technology, since then she has never left! Lind started as a veterinary technician in the ICU, and she has been the supervisor of the ICU/ER since 2012. She received her VTS in emergency and critical care in October 2016. She enjoys teaching new veterinary technicians and veterinary students. She strives to prepare them for their careers ahead.

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PRACTICE Pulse QUESTION: Are veterinarians required to abide by Section

456.42(3) of the Florida Statutes requiring that all prescriptions be submitted electronically as of July 1st, 2021? Electronic prescribing software systems are prohibitively expensive for most veterinary hospitals. My understanding was that veterinarians are not regulated by Section 456.42, but I have had a pharmacy refuse to fill a written prescription for my patient without an electronic submission of the prescription.

Section 456 covers human medicine medical professionals. Veterinarians are covered under Section 474. To help veterinarians with this matter, our legal counsel worked with the Board of Pharmacy to achieve the following: The Board has clarified to pharmacies and on their website that this bill does not impact veterinarians.

QUESTION: Can a chiropractor who is certified in animal chiropractic practice chiropractic on animals in the state of Florida?

A: In Florida, in the practice of veterinary medicine, a chiropractor

must have a relationship with a licensed veterinarian and work at the direction of the veterinarian in order to practice on animals.

phrase is defined in subsection 474.202(5), F.S., with the exception of the following tasks which may be performed without the licensed veterinarian on the premises: (a) The administration of medication and treatment, excluding vaccinations, as directed by the licensed veterinarian; and (b) The obtaining of samples and the performance of those diagnostic tests, including radiographs, directed by the licensed veterinarian. (2) The administration of anesthesia and tranquilization by a veterinary aide, nurse, laboratory technician, intern, or other employee of a licensed veterinarian requires “immediate supervision” as that phrase is defined in subsection 474.202(5), F.S. (3) The administration of any vaccination by a veterinary aide, nurse, technician, intern or other employee of a licensed veterinarian which is not specifically prohibited by Rule 61G18-17.006, F.A.C., requires “immediate supervision” as that phrase is defined in subsection 474.202(5), F.S. The FVMA has been advised by legal counsel that as long as the veterinarian has directed it, and as long as the technician does not perform surgery, anesthesia, tranquilization, or any vaccination, anything else they perform as “treatment,” including first aid, heat support, bandaging or similar treatment to stabilize the animal, is allowed by Board Rule. The technician is acting under supervision/direction of the veterinarian when performing their delegated duties.

QUESTION: What does a relationship with a veterinarian QUESTION: In Florida, can we charge for written controlled mean exactly? Is it a referral or does the chiropractor have to work IN a veterinary clinic? Could I open a practice and work under referrals from more than one vet?

Rx?

A: There is no law which says you cannot charge for any service.

Charging for writing a prescription would be a business decision.

A: You do not have to work in a veterinary clinic. Referrals from

a licensed veterinarian and your provision of a report to him/her are adequate. In this relationship, it is the veterinarian’s license under which you provide chiropractic services.

QUESTION: I am an associate veterinarian. I have elderly

A: The Florida Rule regarding technicians’ tasks can be found at:

clients with two elderly cats in renal failure. The pets would benefit from subcutaneous fluids two-three times weekly. The clients live about 20 minutes away, and it is very difficult for them to gather up both cats and bring them in every other day, not to mention road safety concerns. They are unable to do the treatments themselves, but would love to pay someone to come to their house to do it for them.

(1) All tasks which may be delegated to a veterinary aide, nurse, laboratory technician, intern, or other employee of a licensed veterinarian shall be performed only under the “immediate supervision” of a licensed veterinarian as that

Is that legally allowed? I have a former employee that is competent and now has a business license for house-call nail trims, baths, etc. Can I get that former employee to go to my client’s house to do subcutaneous fluid therapy on their two cats?

QUESTION: Can you direct me as to where I can find Florida-specific practice guidelines for veterinary technicians? 61G18-17.005 Tasks Requiring Immediate Supervision.

30 | FVMA Advocate

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.-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.

A: Yes, you can instruct a former employee that is competent to go to your client’s house and do subcutaneous fluid therapy. The rule on tasks requiring immediate supervision states that the administration of medication and treatment, as directed by the licensed veterinarian, can take place without the veterinarian on premises.

455.275 Address of record.— (1) Each licensee of the department is solely responsible for notifying the department in writing of the licensee’s current mailing address, e-mail address, and place of practice, as defined by rule of the board or the department when there is no board. A licensee’s failure to notify the department of a change of address constitutes a violation of this section, and the licensee may be disciplined by the board or the department when there is no board. (2) Notwithstanding any other provision of law, service by regular mail or e-mail to a licensee’s last known mailing address or e-mail address of record with the department constitutes adequate and sufficient notice to the licensee for any official communication to the licensee by the board or the department except when other service is required pursuant to s. 455.225. (3)(a) Notwithstanding any provision of law, when an administrative complaint is served on a licensee of the department, the department shall provide service by regular mail to the licensee’s last known address of record, by certified mail to the last known address of record, and, if possible, by e-mail. (b) If service, as provided in paragraph (a), does not provide the department with proof of service, the department shall call the last known telephone number of record and cause a short, plain notice to the licensee to be posted on the front page of the department’s website and shall send notice via e-mail to all newspapers of general circulation and all news departments of broadcast network affiliates in the county of the licensee’s last known address of record.

QUESTION: Is it okay to require only English to be spoken

while on the floor working? The rationale being "to avoid any miscommunication" among staff members? Unless of course, there is a need to communicate with a client in their native tongue.

A: It

is against U.S. EEOC law to require English only in the workplace with the exception of employer/employee safety. For personal conversations, we cannot ban anyone from speaking a language other than English in the workplace.

QUESTION: I am a veterinarian in the state of Florida. I graduated in May of 2020. I want to know exactly how much CE I should have and by what date I need to have it completed. Grateful for any information you can provide me.

A: No CE is required for your first license renewal, which should be June 1, 2022. See the reference in the statute below.

61G18-16.002 Continuing Education Requirements for Active Status License Renewal. (5) A licensed veterinarian shall not be required to complete a continuing education requirement prior to the first renewal of his license, but it shall be required prior to any subsequent renewal.

61G18-10.0065 Notice to the Department of Mailing Address and Place of Practice of Licensee.

QUESTION: I am employed as the sole practitioner at a facility;

however, my Florida veterinary license lists my home address as I previously worked as a contract veterinarian prior to my permanent employment. Is there any legal reason why I would need to change the address on my vet license to reflect my current place of employment?

A: The address on the license should remain the same. That

is your mailing address. Under the rule (61G18-10.0065), you should send a certified mail letter to the Board regarding your current address and “place of practice.” We’ve reproduced the applicable rules below for your reference.

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Each licensee and registrant shall provide by certified mail written notification to the department the licensee’s current mailing address and place of practice upon change thereof or license renewal. The term “place of practice” means the address of the physical location where the veterinarian practices veterinary medicine.

END NOTE: The ultimate responsibility

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

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CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED

VETERINARIAN RESIDENT WANTED – CLEARWATER AND WESLEY CHAPEL, FL: The Pet Dentist at Tampa Bay—Clearwater and Wesley Chapel, FL: The Pet Dentist at Tampa Bay is seeking a full time resident for its AVDC approved residency program, beginning in 2022. With two locations in the Tampa Bay area, our practice offers mentorship from two board-certified veterinary dentists. Our practice on the west coast of Florida continues to grow thanks to over 20 years of relationships with local general practitioners and specialists. Our offices have great support staff including certified veterinary technicians and receptionists. The caseload is diverse and includes all aspects of veterinary dentistry and oral surgery. Practice locations are recently renovated and offer state-ofthe-art equipment. Applicants are required to have completed a one-year internship or equivalent experience in private small animal practice. We offer a competitive salary and benefits package and a 5-day work week. A letter of intent, curriculum vitae, and three references should be sent via email to thepetdentist@gmail.com. For more information about the program, contact Dr. Chris Smithson or Dr. Michael Peak, phone: 813.406.4800. (4/21 / #592) VETERINARIAN WANTED – KISSIMMEE/ORLANDO, FL: Osceola Animal Clinic is seeking a full or part-time small animal veterinarian. We are a privately owned hospital providing full medical and surgical services. Our equipment includes: in-house CBC and Chemistry machines, anesthetic monitoring, digital radiography and digital dental radiography, therapy laser and ultrasound. We see a variety of medical cases and perform numerous surgeries including some orthopedic procedures. We can provide excellent support staff, up-to-date equipment and longterm client base to a new associate. We are seeking someone with excellent communication skills and an enthusiasm for veterinary surgery, medicine and dentistry. We are happy to mentor a new graduate. Our schedule allows for a great work-life balance: four-day workweek and alternating Saturdays. The local emergency clinic manages overnight needs. Salary is negotiable based on experience and includes paid vacation days, holidays and sick time. Each veterinarian has a CE allowance, provision of health and liability insurance, and payment of license renewals. Central Florida offers entertainment to everyone- from theme parks to nature parks, beaches to restaurants, and sports to shoppingthere’s always something to do. Please contact Dr. Tom Beaudry at OAC1944@yahoo.com if you are interested in joining our team. We look forward to hearing from you! (4/21 / #26746) VETERINARIAN WANTED – BELLEAIR BLUFFS, FL: Work-life balance nestled within 1 mile of beautiful beaches – Belleair Bluffs, FL Bluffs Animal Hospital is an AHAA accredited small animal general practice that is located in Belleair Bluffs on the west coast of Florida within Pinellas County. We are located minutes from beautiful beaches in Clearwater and Indian Rocks and in close proximity to Tampa, St. Pete, and Dunedin. We are a privately owned clinic and have been since 1961 with no interest in transitioning to corporate. Bluffs is a walk-in clinic that only requires appointments for surgery, boarding, and grooming. This allows us to spend adequate time with patients and provide the best care possible while offering opportunities for both traditional general practice and emergency medicine. We place a high emphasis on quality of life and work life balance. We are open from 8-5:30 during the week with a one-hour lunch break. On Saturday we are open from 8-12:00. Our doctors have one full day off during the week as well. We do not require any after hours on call. We strive to practice high quality medical care with current best practices dictated by evidence-based medicine. We have APR Vet digital radiograph unit, Acuson X300 ultrasound, MidMark VetPro DC dental radiograph unit, SurgiVet surgical monitors, and Companion Animal therapeutic laser. We are currently looking for a full-time veterinarian to come join the Bluffs team. We are happy to offer mentorship and encourage new graduates to apply. We offer a competitive salary and benefits. Salary starts at 100,000; increase pending experience. We have exceptional health care benefits, paid CE, vacation. We are offering a sign-on bonus to assist with relocation or other associated costs. Contact us today to set up a visit! 860.877.5049 or email us at info@bluffsanimal.com. (4/21/ #2291)

32 | FVMA Advocate

REGIONAL VETERINARY MEDICAL DIRECTOR – ANYWHERE IN FLORIDA: Pet Paradise is currently searching for a Regional Veterinary Medical Director for our clinics in the state of Florida. This position is charged with successful implementation of veterinary services within their market. The RVMD will ensure all clinics deliver best practices, aligns with the resort, and makes decisions based on our core values. This individual will work closely with and reports directly to the Chief Veterinary Officer to implement strategies to enhance patient care through our medical offerings. This individual will hire, mentor, engage and develop effective and productive veterinary teams. For more information please contact Dr. Jaime Pickett by email at jpickett@petparadise.com. (4/21 / #38301) VETERINARIAN WANTED – ST. PETE BEACH, FL: Enthusiastic veterinarian needed in a busy 2-doctor small animal practice located on beautiful St. Pete Beach. St. Pete Beach was voted Trip Advisor's number one beach in the U.S. and number five in the world. Walk across the street and watch the sunset over the Gulf of Mexico after work. Our clinic was founded in 1998 and remains the only veterinary clinic on St. Pete Beach. In addition to the beautiful weather, we enjoy excellent, loyal clientele and friendly, helpful staff. Experience is required. We offer digital x-rays, ultrasound, laser and cold laser in a beautiful, modern and spacious facility we built from the ground up. No emergency service. Competitive salary and benefits package with buy-in potential. For more information please contact Cheri Rose at 727.458.3192 or by email at crose4@tampabay.rr.com. (4/21 / #25877) VETERINARIAN WANTED – FLORIDA SPACE COAST: COME GROW WITH US! A privately owned network of three veterinary hospitals on Florida’s Space Coast. We are looking to expand our staff with a full-time associate as well as a weekend only associate at a newly renovated 8000 sq ft hospital on Merritt Island. Our Viera location, which will be breaking ground on a brand-new facility this year, is also looking for a full-time associate immediately. Island Animal Hospitals are AHAA accredited, multi-location, 10 doctor veterinary hospitals with a third office located in Cocoa Beach. Island Animal Hospitals focus on high quality preventative medicine and surgery with compassionate care and education. Our progressive hospitals are equipped with the latest in technology, including advanced dentistry, radiology, echocardiograms, rehabilitative services, and surgery. We are also fully equipped for laparoscopic procedures and endoscopy. We are seeking energetic, selfmotivated, enthusiastic veterinarians that strive to provide high quality medicine in a warm and compassionate environment. Applicants must possess good communication skills and a desire to foster a lasting relationship with our hospital and patients. Compensation package is competitive, and benefits include four weeks paid vacation, health, dental and vision insurance, continuing education allowance, membership dues, and many others. All experience levels will be considered. Please send resume with cover letter highlighting your interests to Myvet@IslandAnimal.com NOTES: Additional Salary Information: Salary based on experience. (4/21 / #4223) VETERINARIAN WANTED – ATLANTIC BEACH, FL: ARE YOU A VETERINARIAN THAT WANTS TO WORK IN A FAMILY OWNED SMALL ANIMAL PRACTICE THAT MAINTAINS A POSITIVE IMAGE IN THE COMMUNITY? San Pablo Animal Hospital is a well-established, full-service veterinary hospital providing comprehensive medical, surgical and dental care. We are located one mile from beautiful Atlantic Beach, Florida, and just twenty minutes from downtown Jacksonville. We offer in-house lab and pharmacy, HD digital radiographs, class-IV laser therapy, anesthesia monitoring and digital dental radiographs. We are open M-F and Sat. mornings. Our desire is to provide our clients with excellent customer service, yet have “a life outside of veterinary medicine!” We are looking for a full time associate that enjoys developing a personal rapport with clients and their pets. Benefits Offered: A 4 day/week schedule with rotating Saturdays, $85,000-$120,000 depending on experience and production, a stipend for continuing education, dues for AVMA, FVMA and JVMA, licenses, health insurance with dental and vision, a SIMPLE IRA with matching funds, professional liability insurance. Requirements: DVM, Florida License. Send resume to MCMDVM54@gmail.com. (4/21 / #1313)

VETERINARIAN WANTED – TITUSVILLE, FL: ASSOCIATE VETERINARIAN wanted to join a thriving practice on the Space Coast in Titusville, Florida. We are looking for a passionate, compassionate, energetic veterinarian. We offer a modern, well-equipped hospital with digital radiology, in-house Idexx laboratory equipment including blood chemistry and urine analyzers, class IV laser, easy access to ultra sound and CAT scan imaging. We are a small animal clinic caring not only for our furry friends, we also care for some exotics, birds and the occasional pet farm animal. In addition to well care and medical services, we provide a wide variety of surgical procedures in hospital. We offer a competitive salary, paid time off, CE benefits, and will cover the cost of state and national license fees. No after hours shifts, and every other Saturday off. Experience is a plus, and new graduates are welcome to apply. Possible buy-in for the right individual. Contact: Rita Curry 321.607.6897 by email at animalcare940@gmail.com. (Issue 4, 21/ #26920) VETERINARIAN WANTED – OVIEDO, FL: Central Florida Animal Hospital is seeking a full-time Associate Veterinarian to join our team. We are a well established and growing small animal hospital. We offer a very friendly and flexible work environment with an emphasis on compassionate Veterinary care and top notch client service. We can make a schedule to suit any needs and welcome new graduates or seasoned veterans. If you have a true love for our profession and a desire to learn every single day, we want you! Contact Dr. Bob Moja or Danielle Wiebe, 407.366.4535 or CentralFLAH@gmail.com. (4/21/ #15571) VETERINARIAN WANTED – LUTZ, FL: Livingston Animal & Avian Hospital is seeking a full-time veterinarian to join our dedicated, compassionate team. We are located just north of Tampa, in Lutz, Florida near USF. Looking for someone who is personable, wants to practice quality medicine in a homey setting, and enjoys getting to know our patients and their people. Must be able to do routine surgeries please. We have sane hours and are close to many excellent specialists if referral is needed. Ability to treat birds & exotics is a plus but not a deal breaker. Salary and benefits commensurate with experience. Would also consider part-time or regular relief work if mutually beneficial. For more information, please contact Dr. Suzanne Topor at laahvets@aol.com. (4/21/ #18802) ASSOCIATE VETERINARIAN – FT/PT WITH SIGNING BONUS (GULF BREEZE, FL): Gulf Breeze Animal Hospital is a thriving privately owned practice looking for an energetic, dynamic veterinarian that is passionate about medicine and the human/animal bond. We offer competitive salary, with $10,000 signing bonus. Benefits package includes medical, dental and vision insurance, 401(k), paid vacation, paid sick time, a continuing education allowance, payment of AVMA and FVMA dues and professional liability insurance coverage. For more information please contact Carole Ittner at 850.932.6116 or by email at gbahospital@mchsi.com. (4/21 / #11813) VETERINARY WANTED – SEBRING, FL: The Affordable Pet Care Clinic has a position available for a doctor that would enjoy the best of public and shelter medicine. Our clinic is associated with The Humane Society of Highlands County, a no-kill animal shelter. Our shelter was completely rebuilt 5 years ago. Our animals are well cared for. Our public clinic is equipped with Digital x-ray, ultrasound, Abaxis lab analyzers, dental and cauterizing equipment. Our OR has a multifunctional heart monitor. The staff is experienced and easy to work with. We take scheduling seriously to not over-book appointments. There are no afterhours requirements. Our clinic does not turn away an animal in need for lack of funds. We believe all animals deserve quality care regardless of the owner’s financial status. Our clinic is in danger of having to close our doors if we cannot locate a veterinarian. That would be tragic for the thousands of animals we treat, many that without us, they would not have access to care. Our current vet is most likely re-locating back home. We will help with housing, moving costs, licensing fees, and medical insurance. We are in Central FL, Sebring area, a city that is not too big or too small. We are only 1hr and 30mins from either coast. Our compensation is $90,000 - $125,000 per year.Call us today at 863.214.6508 for a virtual live tour of our facility. (Issue 4/21 / #51381)

VETERINARIAN| CRYSTAL RIVER, FL| NEW GRADS WELCOME| MIXED PRACTICE: At Crystal River Animal Hospital, we are currently

looking to add an ambitious and passionate associate veterinarian to our team. The ideal candidate is one that hosts both clinical knowledge and compassion for their patients and their clients. Currently, we are a three-doctor practice with an amazing and knowledgeable support staff consisting of five technicians, two receptionists and one pharmacist. Our current hours of operation are Monday - Saturday from 8am to 5pm. We are seeing predominately small animal cases, but we do offer large animal services such as vaccinations, coggins, and health certificates for travel. Lastly, we

also understand that mentorship is a must for a newer DVM and our experienced team of doctors are excited to share their vast amount of clinical experience! Please send resumes to: kfriedrichs@heartlandvetpartners.com. (Issue 4/21 / #51001) VETERINARIAN | DESTIN, FL | FELINE ONLY PRACTICE! Cat Clinic of Destin was established by Dr. Dorothy Flynn in the year 2000. We are the only feline only practice in the area and we pride ourselves on providing quality veterinary care to our patients, as well as educating our loving kitty parents. We are a group of highly trained and experienced cat lovers who are devoted to giving our patients the best care possible. We are a one-doctor practice with a support staff consisting of our practice manager, two well trained technicians, one veterinary assistant, and one receptionist. Our hours of operation are Monday-Friday from 8:30am to 5:30pm and closed for the weekends! We look forward to hearing from you! Send resumes to: kfriedrichs@heartlandvetpartners.com. (Issue 4/21 / #51001)

BANFIELD PET HOSPITAL IS HIRING VETERINARIANS! SIGN-ON & RELOCATION AVAILABLE! Are you looking to flourish

in an environment that emphasizes personal and professional growth? Do you believe in practicing high quality, solution-oriented medicine? Does the thought of being supported by a team of dedicated professionals and given the freedom to practice at the top of your license excite you? Do you want to push yourself, take the lead on growing your career, and have the opportunity to affect change at the hospital level and beyond? If you answered “yes!” to any of the above, we want to talk to you today! Whether you’re an experienced doctor looking for your next adventure, a new graduate seeking to find the perfect fit as you begin your career, or you’re anywhere else along your veterinary journey, the opportunity to grow with Banfield has never been better. Offering structured mentorship, outstanding benefits, powerful scheduling flexibility, and a dedicated focus on the health and wellbeing of our team, Banfield is committed to your success! Sound good? Let’s chat! Reach out to Miranda Adams-Ford at Miranda.Adams-Ford@banfield.com today to learn more about how you can #bhere and #bhappy. Your dream job is waiting, why are you? (Issue 4/21 / #51659)

RELIEF VETERINARIAN

RELIEF VETERINARIAN – SAINT JOHNS COUNTY AND FLAGLER COUNTY, FL: Experience Veterinarian, no dentals, and no surgery. For more information please contact Dr. James Ford at jafjrdvm@gmail.com or by phone at 724.747.8331. (4/21 / #12662)

PRACTICE FOR SALE/LEASE

PRACTICE FOR SALE – PALM BEACH COUNTY FLORIDA: Veterinarian retiring, small clinic in Lake Worth, Florida. Established 31 years. Grossed $310,000 in 2020. Profitable with great potential and low overhead, low stress, and great clients. 1 employee. Owner net is $136,686. For more information, please contact Peter Picciano at 561.707.7830 or by email at Peter@premierbusinessbrokers.com (Issue 4/1 / #50868) PRACTICE FOR SALE – PINELLAS COUNTY, FL: Rare Opportunity to Own a " Well Established Veterinarian Practice" for Sale! Are you ready to run your own " Practice"? The owner is retiring and is ready to sell after 10 years .... Business sale only with a New 10-year Lease and very Low Rent. Great location, with ample parking and adjacent to other businesses for more business referrals. Asking $250k, Contact Minh Ho @ 813.530.6674 or minh@mmselection.com (Issue 4/21 / #51547) PRACTICE FOR SALE – WINTER PARK, FL: SmRecently vacated (former VCA) animal hospital in Winter Park on busy main road. Approximately 4,900 sq ft, 23 parking spaces, on .61 acres. For lease or sale. Call Dr. Barry Render at 407.579.0600. Perfect setup for a growing practice.(4/21 / #51988)

EQUIPMENT FOR SALE/LEASE

X-RAY SYSTEMS FOR SALE – FLORIDA: DIGITAL AND STANDARD X-RAY SYSTEMS, FLORIDA X-RAY SALES FOR MORE INFORMATION, PLEASE CONTACT FRANK BYKOWSKI AT 941.637.0614. (Issue 4/21 / #26934)

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MIAMI-DADE COUNTY: Prime location! Leasehold facility + mobile unit. Gross revenue is over $550K. Option to buy real estate available. (FL105) PALM BEACH COUNTY: Prime location on ocean with dock! $618K gross revenue and $123K afterdebt income. Real estate included. Huge growth potential! (FL107) PALM BEACH COUNTY: Beautiful location and building! $819K gross revenue and $165K afterdebt income. Leasehold facility. Average annual growth rate over 18%. (FL109)

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NEW LISTING! FL, Palm Beach County: SA, Solo Dr. Prx. Leased facility. (FL30W) GA, South Atlanta Area: Solo SA Prx w/RE, Approx 2,217SF efficient facility. Open 4.5 days a week + ½ day Saturday. Well Equipped. PRX & RE. (GA48C) NEW LISTING – NC, Appalachian Mountains: Solo Doctor, 100% SA w/ increasing revenues. Convenient to Charlotte, Winston-Salem, and Greensboro. Home to more than several dozen commercial wine producers, surrounded by the largest concentration of vineyards, wineries and tasting rooms in NC. Real Estate included (NC20Y) NEW LISTING! NC, Crystal Coast Area: Located near the Neuse River area, only 30 miles from Atlantic Beach. SA, Solo DVM. $900K+ 2020 gross. +/- 2 acres included. (NC32N) NC, Piedmont/Triad/Growing Area: AAHA Certified, SA 1.25 Dr. Prx., +/-3000SF spacious facility. Only open 4.5 days a week. Well Equipped. PRX & RE $625K. (NC15B) 1610 Frederica Road, Saint Simons Island, GA 31522 Toll Free: (800) 333-1984 | www.simmonsinc.com Email: southeast@simmonsinc.com Licensed in Florida, Georgia, North Carolina, South Carolina and South Carolina Real Estate Broker

Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809

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

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

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

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