Advocate Issue 4, 2018

F V M A ADVOCATE ISSUE 4 | 2018

THE GULF-ATLANTIC VETERINARY CONFERENCE BOCA RATON RESORT & CLUB, A WALDORF ASTORIA RESORT

A SCIENTIFIC PROGRAM TO ENRICH EVERY MEMBER OF THE SMALL ANIMAL VETERINARY CARE TEAM Details on Pages 14-19

VETERINARY ACUPUNCTURE ~ Page 5 SAFETY IN ANESTHESIA FOR SENIOR PETS SERIES: PART I ~ Page 20

President's MESSAGE "No duty is more urgent than that of returning thanks.” – James Allen I have recently been reminded of the privilege it is to be asked to serve as president of the FVMA. The veterinary profession surrounds me with people who give of themselves whether that’s to care for the large, small, wild or domesticated animals of Florida; to care for the owners and caregivers of those animals; to care for the team members and coworkers of our profession; or to maintain the vitality of the profession of veterinary medicine in Florida.

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

OFFICERS

Dr. Marc A. Presnell President Dr. Michael Epperson President-elect Dr. Donald H. Morgan Treasurer Dr. Alex M. Steverson Past President Mr. Philip J. Hinkle Executive Director

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

Recently, the FVMA sent out a call for volunteers to help the UF College of Veterinary Medicine review the applications of the talented men and women aspiring to enter our profession. We were overwhelmed with your response, and I must say thank you to all who were ready to carve time out from your practices, families and free time to give back to the profession. Drs. Craig Price and Alexander Villarreal will join the admissions committee in selecting our future colleagues, while a second group was selected to help the committee review application packets. I would also like to thank Drs. Bob Encinosa, Michael Epperson, Terri Parrott and Martine Rodgers who have volunteered to serve as FVMA representatives on the newly formed standing committees of the UF CVM Alumni Council. Through efforts like these, the FVMA and UF CVM continue to strengthen their partnership working for the profession in Florida.

The FVMA also participated in the Freshman Orientation for the Class of 2022. Dr. Dani McVety addressed the class on behalf of the FVMA, and Dr. Richard Carpenter participated in the First Year Leadership Experience activities on behalf of the FVMA. Many others, like Dr. Alex Thomasson and the outstanding faculty of UF CVM, gave of their time to help launch the next step in these students’ journey. A big thank you again to everyone involved for sharing your practice experience and wisdom with our upcoming colleagues.

In August, I was privileged to attend the annual AVMA conference and observe the House of Delegates meetings where Drs. Ernest Godfrey and Richard Williams represented the FVMA in making decisions on the national level that affect our profession. Our AVMA delegates work hard to represent you and to be available to hear your questions or concerns. Dr. Williams also serves as chair of the FVMA Legislative Advocacy Committee which constantly reviews legislation that will affect your practice. Legislation for the 2019 session is already being crafted, filed and reviewed, and new opportunities and challenges for our profession are on the horizon. Be ready to call your legislators and share your viewpoint when asked. The committee is on the frontlines for you. Now is the time to give your financial support. This is an election year, and your contributions help the FVMA open doors to discuss the issues affecting our profession.

We have previously had some significant wins, but we need your support to continue to be heard!

The FVMA is also offering two exceptional CE opportunities this fall: the FAEP’s Promoting Excellence Symposium (PES) in Naples, Florida in October with world-renowned equine musculoskeletal system anatomist Dr. Jean-Marie Denoix and The Gulf-Atlantic Veterinary Conference (TGAVC), which will be hosted again at the luxurious Boca Raton Resort and Club in Boca Raton, Florida. Looking toward the future, we have new projects like the Power of 10 and the Wellness Committee to share with you, and I look forward to helping them develop and flourish. As always, I must thank the phenomenal staff of the FVMA that makes it all possible behind the scenes. Stay in touch with your FVMA District Representative for more news and happenings.

Thank you for allowing me to serve.

Respectfully,

Marc Presnell, DVM

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

In Remembrance

Dr. William E. "Bill" Kyser FVMA Past President - 1994

The FVMA mourns the passing of Dr. William “Bill” Kyser, who was a FVMA past president and distinguished leader in the veterinary profession in Florida.

Dr. Kyser passed away surrounded by his loving family on September 16, 2018.

He served as the FVMA president in 1994. Dr. Kyser was bestowed the FVMA’s Distinguished Service Award for his exceptional achievements and contributions towards the advancement of veterinary medicine and the profession in 2002.

Funeral services were held at St. Catherine’s Episcopal Church in Temple Terrace, FL on Saturday, September 22, 2018. A celebration of life immediately followed the service at Temple Terrace Golf & Country Club.

The family requests in lieu of flowers that memorial contributions to honor the late FVMA past president be made to St. Catherine’s Episcopal Church in Temple Terrace.

Dr. James H. “Buddy” Yarborough, III James H. “Buddy” Yarborough, III, DVM passed away at the age of 82 on August 25, 2018, after a brave fight against cancer. He received his DVM degree from the Auburn University in 1964.

He started his own practice called Galloway Animal Clinic with his wife Dr. Charleen Perry Yarborough, DVM. They owned the practice until his retirement in 1997. He was a member of the FVMA and continued to attend FVMA conferences even after his retirement.

He was a member of the Miami Beach Rod & Reel Club for more than 30 years and was very involved in the conservation of marine and fresh water fisheries. His love of salt water angling was only exceeded by his love of veterinary medicine, the pets and owners of his practice who were like family, and his own family which he cherished.

He is the son of the late Dr. James H. Yarborough, who was a prominent FVMA leader. He was the FVMA president in 1945, received the FVMA Distinguished Service Award in 1984, received FVMA’s Veterinarian of the Year in 1959, and was the Champion of Veterinary Medicine in 2005 where two FVMA scholarships were awarded in his honor to two UF CVM students. He is also related to the late Dr. Perry Smith, who was also a past FVMA president who passed away this past spring.

In This Issue 4 7 8 9

| Veterinary Acupuncture | Celebrating our Veterinary Technicians | Member Spotlight | New FVMA Wellness and Well-being Committee Provides Support for Members 10 | FVMA, UF CVM Team up for Annual First Year Leadership Experience 11 | FAEP-UF CVM Student Appreciation Day WWW.FVMA.ORG |

13 | OEC 2018 - SAVE THE DATE 14 | 6th Annual TGAVC - Program Details 20 | Safety in Anesthesia for Senior Pets Series: Part I 24 | Should the Real Estate Be Sold With the Practice?

26 | Practice Pulse 29 | Classified Advertisements THE FVMA |

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Veterinary Acupuncture:

PAVING THE WAY FOR INTEGRATED CARE

By Samantha Rosenthal, FVMA Communications Acupuncture is one of the oldest medical therapies in existence. In China, veterinary acupuncture has been in practice for more than 3,000 years. In the United States, Western Veterinary Medicine (WVM) still dominates when it comes to the health system and practices used by veterinarians, but Traditional Chinese Veterinary Medicine (TCVM) has gained popularity within the last decade among new and seasoned practitioners.

Of the four branches of TCVM, veterinary acupuncture is one of the more popularly practiced therapies due to an increased interest in it as an option to treat a variety of pet ailments. Many practitioners believe the future of veterinary medicine lies within an integrative approach, where TCVM and WVM are both practiced allowing the strengths of each to best serve their patients.

Equine acupuncture points (Copyright of image belongs to Chi Institute – www.tcvm.com) The FVMA spoke with some of its members who are leading experts on the ancient Chinese practice of veterinary acupuncture to discuss being available and scientific articles showing the quantitative data how it’s practiced, why it’s becoming so popular and what lies behind the art form. Additionally, more and more veterinarians are searching for alternative care approaches to ensure their ahead for it within the scope of veterinary care. patients are getting the best treatment.

The History of TCVM and Veterinary Acupuncture

As mentioned, veterinary acupuncture has been long practiced as a means of therapy for animals, yet it wasn’t until the 1970s that it was first recognized in the United States. The International Veterinary Acupuncture Society (IVAS), the first professional veterinary acupuncture society, was established in 1974 in the U.S. to promote the use of this therapy and educate veterinarians and the public alike about its benefits. The first certified veterinary acupuncturist (CVA) exam was given in 1975 with only 80 members belonging to the society at that time. IVAS is now an international organization with more than 1,800 members worldwide.

TCVM has four branches of therapy that are commonly practiced: acupuncture, herbal medicine, food therapy and Tui-na. Within the last decade alone, the popularity of acupuncture has skyrocketed due to more educational resources

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Acupuncture can be used for a variety of reasons on both small and large animals. The IVAS lists the following as some general conditions that acupuncture can help treat for small animals: • musculoskeletal problems (i.e. arthritis) • respiratory problems • skin problems • GI problems When it comes to large animals (i.e. horses), it is used for more functional-type problems, and IVAS lists the below as some possible conditions that can be treated: • musculoskeletal problems (i.e. assisting in rehabilitation of the equine athlete) • neurological problems • respiratory problems (i.e. heaves) • GI problems Veterinary acupuncture derives its techniques from its human practice counterpart. It’s practiced using what are known as main

Bearded dragon getting St36 and Bai Hui for adjunct treatment of metabolic bone disease (Photo courtesy of Dr. Mitsie Vargas) points and the Channel-Organ Systems, which are also sometimes called meridians. These meridians are pathways that allow for the transmission and harnessing of energy (Qi) that helps heal the issue that is being addressed.

“As far as the treatments go for pets, a lot of the points we use are based off what we call a meridian system, which is just energy channels or energy flow,” says Dr. Michael Bartholomew, who is a faculty member at Chi Institute and teaches acupuncture. “A lot of those points were taken and extrapolated from humans, and that’s how we came to start treating pets.”

While it can take anywhere from three to six sessions of treatments to address the clinical signs or issue the pet was brought in for, Dr. Bartholomew, who is an integrative veterinarian for The Animal Hospital of Dunedin, mentions how the No. 1 priority is always using acupuncture to improve the pet’s quality of life. Sometimes when WVM has been exhausted or there isn’t access to the WVM tools or drugs, veterinarians turn to using acupuncture to alleviate clinical symptoms.

Acupuncture in the Field and in Practice

To practice acupuncture, there is an extensive amount of specialized education that a veterinarian must know in order to effectively practice the therapy. Many seek to become certified or attend post-graduate training to acquire this knowledge. This knowledge allows CVAs the ability to decide which approach or methodology is best for the animal that needs to be treated, along with making sure to review both WVM and TCVM treatment plans to ensure TCVM and acupuncture is the best route.

“I think what we’re going to do in veterinary medicine is get out of the generalizations of medicine because that’s where there’s a lot of pitfalls, where you see people saying ‘this fits all.’ You must

Dr. Bartholomew performing acupuncture on one of his dog patients (Photo courtesy of Dr. Michael Bartholomew) do more of a customized approach. For example for one patient, WVM may not be the best or maybe an integrated approach will be the best, or just a TCVM approach may be the best. Having the knowledge of both, you can make better decisions for your patients and your clients as well,” says FVMA 2018 Veterinarian of the Year Dr. Mitsie Vargas, who is a CVA. Dr. Vargas, who owns Orchid Springs Animal Hospital in Winter Haven, Florida, further explains that in third-world countries, acupuncture has a big potential since these countries have limited WVM resources like the drugs needed to treat certain ailments.

When she was in Costa Rica in 2017, she said the veterinarians were telling her they don’t have access to nonsteroidals, like Meloxicam, because everything has to go through the government.

Since they don’t have the resources needed to use certain WVM approaches for diagnosis and treatment, veterinary acupuncture is very popular. With only the use of the hands as the diagnostic tools and a couple of needles, a veterinarian can help patients that would normally never be reached without any kind of other pain medication or diagnostics.

“This is why I love it — it brings you back to the basics,” explains Dr. Vargas. “You’re a diagnostician — use your hands. Look at the animal and get all of the information from how the animal is walking, behaving and everything, and using your hands to diagnose the problem."

Dr. Bartholomew agrees that while certain things can be better handled with WVM, there are some things TCVM can address better. Like many other CVAs across the U.S., he receives many referrals where patients are coming in already on all the kinds of medications that are used according to a more WVM-type treatment plan. This is when he then turns to TCVM practices like acupuncture to see if he can address the ailment through an alternative approach. While Dr. Bartholomew has been practicing veterinary acupuncture for 15 years, he started teaching in 2008.

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He later went on to receive his master’s degree from Chi Institute, where he was the first individual to earn the degree from this leading TCVM institution that is located in Central Florida.

Chi Institute: Leading the Way for TCVM and Acupuncture

Recognized as the leading veterinary continuing education provider of TCVM, Chi Institute was founded in 1998 by Dr. Huisheng Xie who is an internationally recognized subject expert on all things TCVM, including acupuncture. He started Chi Institute with the mission to provide high-quality TCVM education, focusing on teaching the best TCVM practices, approaches and techniques that would help meet the needs of the international veterinary community.

Dr. Xie performing acupuncture on a dog patient (Photo courtesy of Dr. Huisheng Xie)

Dr. Xie, who also is a clinical professor for the UF College of Veterinary Medicine, has been interested in TCVM, specifically acupuncture, since he was 8 years old. He was originally going to become a physician who practiced Chinese medicine on humans until his childhood dog Shan-Shan passed away. It was because of this pivotal moment that he decided that he would pursue veterinary medicine and practice acupuncture along with the other branches of TCVM. “TCVM is a holistic approach that is suited to assessing the wellbeing of the whole patient. Treatments are generally non-invasive with few side effects; however, TCVM lacks the tools necessary to pinpoint illness to specific disease-causing agents, like pathogenic bacteria or viruses, and treatments are better suited for chronic conditions than acute ones,” Dr. Xie explains. “In many ways, TCVM and WVM each has what the other lacks; thus, the best medical system involves the integration of the two systems so that the strengths of one can compensate for the weaknesses of the other.”

This is the philosophy that supports Chi Institute’s mission and goal: emphasizing that the integration of TCVM and WVM is the best way to treat patients with the focus on education and tools for the TCVM side of possible diagnosis and treatment.

Chi Institute, located in Reddick, Florida, boasts unique features — small class sizes to promote an intimate learning environment and a more hands-on experience — that make it a suitable learning environment for young and seasoned veterinarians alike. They offer certification in all four of the TCVM branches, and they also offer advanced acupuncture courses in addition to the basic courses taught for certification needs.

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Dr. Xie says he is inspired by his students' passion to practice acupuncture with success, and he is proud of the work that they're doing along with the work his faculty is doing to advance veterinary acupuncture.

The Future of Veterinary Acupuncture

Drs. Xie, Bartholomew and Vargas all agree that getting more research published and making acupuncture a more mainstream and accepted therapy is important, and it will allow for its continued growth in interest and popularity among veterinarians that are in all paths of their professional careers.

Dr. Bartholomew hopes that in the future practitioners can go forward together to promote both WVM and TCVM practices to promote offerings treatment plans that will best help pets for whatever ailments they possess. He, like many, believes this is the future of veterinary medicine. When practitioners are better informed about veterinary acupuncture and its benefits, they can better educate clients so that they understand and know what it can do for their pets.

“We’re taught that everything is either black or white but in reality it’s a lot of shades of gray,” Dr. Vargas says. “The health system sometimes tries to make a standard cure or practice without taking into account other peculiar things about the animal like personality, environment and breed. There’s a lot of factors that play a role in disease. If you don’t take care of them, you might always be putting out fires and treating symptoms but never get to the root of the problem. The perspective of TCVM is to find the root and everything else will go back to normal.”

Celebrating

OUR VETERINARY TECHNICIANS THE FVMA SALUTES VETERINARY TECHNICIANS DURING NATIONAL VETERINARY TECHNICIAN WEEK OCTOBER 14 – 20, 2018

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Veterinary technicians play a vital role in veterinary medicine, and we celebrate their hard work, passion and commitment to excellence. As the voice of veterinary medicine in Florida, we are honored to serve them and all of our 5,000 members and the nearly 80 percent of veterinary practices we represent across the state.

To further recognize the outstanding contributions of veterinary care teams in our industry and to support both team member career development, we invite all Florida veterinary technicians and veterinary team members to join our new veterinary team member affiliate membership programs to better serve these distinguished professionals.

Operating under the umbrella of the FVMA, these organizations extend the reach and mission of our association by offering affiliate membership and exclusive benefits to eligible individuals. These benefits include: • career networking opportunities with thousands of veterinary colleagues • a dedicated staff of FVMA professionals committed to your success (available Monday - Friday, from 8 a.m. - 6 p.m.)

• discounts on world-class CE and conference registration • updates on the latest news and issues impacting veterinary medicine • legislative and regulatory advocacy • membership card, certificate, pin, and much more!

We encourage eligible team members to join us and add their voices to strengthen our profession and their careers.

On behalf of the FVMA membership team, Executive Board, staff and all those who benefit from their veterinary technicians’ dedication to their careers and the animals they care for, we extend our sincerest gratitude and wish everyone a wonderful and successful year.

If you know a certified veterinary technician or animal care technician who has done a truly outstanding job this year and gone above and beyond to support their practice and care for clients, consider nominating them for the FVMA’s CVT of the Year or Team Member of the Year award, to be handed out at our annual conference in May. For more information about affiliate membership and for applications for each, please visit fvma.org, or email us at info@ fvma.org. We also can be reached by phone at 407.851.3862 or toll-free at 800.992.3862.

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MEMBER SPOTLIGHT

FVMA MEMBER NAMED 2018-2019 AVMA CONGRESSIONAL FELLOW FVMA member Dr. Meera Chandra was chosen as one of two 2018-2019 American Veterinary Medical Association (AVMA) congressional fellows. Dr. Chandra is a 2018 cum laude graduate of the University of Florida, and she has both a doctorate of veterinary medicine from the University of Florida College of Veterinary Medicine and a master's in public health from the UF College of Public Health and Health Professions. She will serve for one year as a full-time staff member for a congressional office or committee in Washington D.C. “I have always wanted to pursue a career in veterinary public health. I am interested in the overlap between human and animal health especially in regards to issues like zoonotic diseases and antibiotic resistance,” says. Dr. Chandra. “I believe the AVMA Fellowship will provide an amazing opportunity to help bridge the gap between animal health, human health and public policy. I will have the opportunity to serve as a scientific advisor to Congress and help influence legislation related to veterinary medicine. I am so thankful for this opportunity and am excited to see what my future holds as a public health veterinarian.”

During her time at UF CVM, she completed externships at the Department of Homeland Security in Washington D.C. and the World Organisation of Animal Health in Paris. She also served as president of the University of Florida’s Public Health and Services Club while at UF.

Photo courtesy of Dr. Meera Chandra Dr. Chandra interviewed with congressional offices in September prior to receiving her year-long assignment. During her year in Washington D.C., she will act as an adviser to policymakers regarding issues that will or could affect veterinary medicine, including food safety, animal welfare and public health.

UF CVM DEAN HONORED WITH NATIONAL VETERINARY BUSINESS AWARD UF College of Veterinary Medicine’s Dean James W. Lloyd, DVM, Ph.D. was awarded VetPartner’s 2018 Distinguished Life Member Award. Dr. Lloyd, who became the UF CVM dean in 2013, is one of only 13 members to receive this prestigious award.

Photo courtesy of UF CVM

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“Known as a key thought leader in the area of animal health economics, Lloyd has also worked as an organizational development consultant, emphasizing strategic planning and

leadership development with inclusion as a core element. Lloyd led the National Commission on Veterinary Economic Issues working group on enhancing the skills, knowledge, aptitude and attitude of veterinarians from 2000-2009. He works to progressively apply the disciplines of economics, management and business to the veterinary medical profession through research, teaching and service/administration,” said a statement released by the UF College of Veterinary Medicine regarding Dr. Lloyd being honored with the award.

Established in 2002, VetPartner is a national nonprofit veterinary business group with a mission to provide a community of networking and collaboration for its veterinary medical professional members. The Distinguished Life Member Award is an annual award given to a member who has dedicated their lifelong career to helping make positive contributions to the practice of veterinary business consulting.

New FVMA Wellness and Well-being Committee Provides Support for Members PHILLIP RICHMOND, DVM

The committee will provide education on these topics through available channels like The Advocate, newsletters, the FVMA website, and lectures and workshops at conferences. The committee will also issue a call for colleagues to be of service and form a statewide peer support network. We also hope to offer support groups in the larger metropolitan areas within the next year. Our work will begin with assisting in the implementation of in-clinic wellness and well-being programs, along with being of service to our student members at the UF College of Veterinary Medicine.

Earlier this year, the FVMA chose to bring the importance of wellness, well-being and self-care to our colleagues with the creation of the FVMA Professional Wellness and Well-being Committee. One of the results of the national push for wellness and well-being was the Merck Veterinary Wellbeing Study, which highlighted many of the issues we encounter as veterinarians. The authors concluded that one in 20 veterinarians are suffering from serious psychological distress.

It is my honor to serve as chair of this committee. The committee will help shape the foundation for wellness and well-being for the profession in the state. Our respected committee members are Drs. Dani McVety, who is the CEO and co-founder of Lap of Love, Inc.; Juan Samper, who is the UF CVM dean for students and instruction; Nanette Parratto-Wagner, who is a past chair of the Florida Board of Veterinary Medicine; and Cherie Buisson, who works at Helping Hands Pet Hospice and is a freelance writer.

The FVMA is excited to move forward with this initiative and begin taking these crucial steps to ensure the well-being of its members.

In addition, there is a mental health treatment gap in our profession — a significant population is not getting the treatment they need. The authors recommended organizations educate members about the signs, symptoms and rates of mental health issues among veterinarians. Because of this, our committee will evaluate, improve, and more effectively publicize existing and new organizational resources.

The Professional Wellness and Well-being Committee's purpose is to provide Florida veterinarians with resources and support for chemical dependency, psychiatric illness, eating disorders, anger management, professional burnout and compassion fatigue. The goal is to provide veterinarians with better resources that address issues like work-life balance, job satisfaction, how to deal with work and life struggles, and create awareness and prevention of suicide within the profession.

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Dr. Philip Richmond received his DVM degree from the University of Florida College of Veterinary Medicine in 2006 and earned a BS in biology from the University of South Florida.

He currently serves at the chair of both the FVMA Wellness and Well-being and FVMA Outreach committees. His clinical special interests include orthopedics, soft tissue surgery, cardiology, dentistry and anesthesia/pain management. In addition to being a member of the FVMA, he is a member of the Suncoast Veterinary Medical Association and American Veterinary Medical Association. Dr. Richmond practices at Country Oaks Animal Hospital in New Port Richey, Florida.

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FVMA, UF CVM Team up for Annual First Year Leadership Experience

The Florida Veterinary Medical Association sponsored the UF College of Veterinary Medicine’s annual First Year Leadership Experience (FLE) for UF CVM students at Camp Kulaqua on August 14-15. FLE provides a learning experience for students to promote teambuilding and camaraderie as they begin their journey in veterinary medicine.

The program for FLE 2018 touched on important topics for veterinary students, including discussions on leadership, situational ethics, veterinary school expectations, and academic and professional standards. UF CVM faculty participated as small group facilitators and in large group discussions, and will serve as great mentors as they guide the students along their journey through veterinary school. FVMA provided lunch for the veterinary students, along with T-shirts for them to wear during activities throughout the two days.

UF Director of Student Affairs and former FVMA board member Dr. Amanda House chaired the event along with the help of several UF CVM faculty and staff. UF CVM faculty and FVMA leaders led conversations that allowed the students to get to know each other and the UF CVM better. A total of 118 students participated this year with 25 student facilitators, 15 faculty facilitators, 14 Office of Student Involvement staff and UF CVM Dean Dr. Jim Lloyd. FVMA past president Dr. Richard Carpenter attended the event on behalf of the FVMA and spoke with the students about how the FVMA is a resource for them along their veterinary school journey.

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“FLE has been a special part of CVM orientation for over 10 years and is an opportunity for students to get to know each other, build relationships with some of our faculty and staff, and learn more about themselves with a focus on their individual strengths,” Dr. House said. “We are so thankful to the FVMA for supporting this important event that helps our new students learn more about the professional and college community that they are now a member of.”

The students enjoyed and valued the involvement of both the FVMA and UF CVM in providing two days of educational fun to help prepare them for their next four years of veterinary school.

“The University of Florida CVM has made the FLE a tradition for incoming vet students. This is the beginning of the students’ experience in the profession, and we are very thankful to the FVMA for the continuous support to help provide that opportunity,” said newly appointed UF CVM Associate Dean for Academic & Student Affairs Dr. Juan Samper, whose office assisted in overseeing the activities for FLE. “I look forward to continuing to work with the FVMA as a team for the benefit of our students and the profession”

FAEP-UF CVM Student Appreciation Day The FAEP hosted its annual University of Florida College of Veterinary Medicine Student Appreciation Day on August 25 in Ocala, Florida. The event featured a day of hands-on labs for UF CVM students interested in pursuing equine veterinary medicine. Students had the opportunity to learn about a variety of topics ranging from training Thoroughbreds to taking ultrasounds and X-rays to learning different types of therapies for horses. Students rotated through several area locations to gain valuable equine training experience.

“The FAEP appreciates the opportunity to co-host an event like this with the UF College of Veterinary Medicine,” FAEP President Dr. Ruth-Anne Richter says.

“Educating students about the different important topics of equine medicine is crucial for their professional development. Student Appreciation Day provides unique experiences for students to work with the leading subject matter experts in Florida on equine medicine at some of the most high-profile training facilities in the U.S.” FAEP would like to thank UF CVM for partnering with us to provide students with this unique experience, along with each site location and our event sponsors: Boehringer-Ingelheim, Equine Medical Center of Ocala, Equine Performance Center, Florida Equine Veterinary Associates (FEVA), GoldMark Farm, Henry Schein Animal Health, Niall Brennan Stables, Ocala Equine Hospital, Peterson & Smith Equine Hospital, and Zoetis.

FEVA

Goldmark Farms

Equine Performance Center

Ocala Equine Hospital

Equine Medical Center of Ocala

Peterson & Smith

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SAFETY IN ANESTHESIA FOR SENIOR PETS SERIES: PART I RALPH HARVEY |DVM, MS, DACVAA SUMMARY

Photo courtesy of Dr. Ralph Harvey

Senior patients in need of a procedure requiring anesthesia can be managed to maintain a favorable balance between risk and derived benefit. Medically important and indicated procedures should not be discouraged based on chronologic age alone. An important and commonly encountered example in geriatric patients is the need for dental care. Expert opinion and data strongly support the use of general anesthesia for dentistry and discredit the alternative approach of so-called “anesthesia-free” dentistry.1 The anesthetic and perioperative care of geriatric animals requires increased vigilance and support. The margin of acceptable physiological variation is probably narrower than in younger patients. Underlying disease, which is often subclinical, influences metabolism and recovery from anesthetics and also predisposes the patients to adverse outcomes. Geriatric patients are typically less able to tolerate medical challenges than are younger animals; thereby, they require increased physiologic support and anesthetic monitoring. There is an increase in required resources and costs to appropriately care for senior pets, but the investments in better anesthetic care increase safety and success.

ANESTHESIA IN SENIOR PETS

Years ago, we noted that anesthesia for geriatric patients was not an uncommon requirement.2 Since then, improvements in veterinary care and client dedication have contributed to increasing the lifespans of companion dogs and cats. The geriatric patient is defined more by physiologic and physical condition than by chronological age. As an approximation, it has been suggested that an animal is “geriatric” when it has reached 75-80 percent of normal expected life span. However, each patient must be evaluated as an individual and many older animals remain remarkably fit, while others appear to age rapidly. The medical management of geriatric patients is a prominent part of veterinary care. Information on the specific needs of older dogs and cats is increasingly available.3 As owners responsibly care for their pets, and as we provide more skilled medical care, the life expectancy of dogs and cats can be substantially increased.

PHYSIOLOGICAL CHANGES ASSOCIATED WITH AGING

Although every patient varies with regard to the geriatric changes present, there are some general considerations with regard to altered physiology during aging. The geriatric patient is likely to have a higher incidence of disease and organ dysfunction than is a younger patient. Less obvious is the reduction in functional organ reserve capacity relative to the young patient.4 This decreased organ reserve, termed geriatric or 20 | FVMA ADVOCATE

elderly normal, may not be apparent until the patient is stressed by disease, hospitalization, anesthesia or surgery, at which time overt organ failure may occur. Chronologic age serves as a poor surrogate for recognition of the accumulation of specific disease states and physiologic deterioration that typically accompanies advanced age and better informs risk analysis. Much of our knowledge regarding geriatric changes in veterinary patients is based on observations in human medicine. It is expected that similar aging changes apply to veterinary patients. Aging pets also serve as valuable animal models of human disease and deterioration, closely paralleling the familiar declines observed in geriatric humans.

Cardiovascular Changes

There is a reduction in cardiac reserve capacity in geriatric patients compared to younger patients. This may commonly limit the ability in the geriatric patient to compensate for cardiovascular changes that occur during anesthesia. Geriatric

2018

T G A V C THE

6 ANNUAL th

GULF-ATLANTIC VETERINARY CONFERENCE

BOCA RATON, FLORIDA

DECEMBER 6-9, 2018

Big conference benefits with CE APPROVED BY:

■ AAVSB RACE - AMERICAN ASSOCIATION OF VETERINARY STATE BOARDS RACE, PROVIDER #532 ■ SPONSOR OF CONTINUING EDUCATION IN NEW YORK STATE ■ FLORIDA BOARD OF VETERINARY MEDICINE, DBPR FVMA PROVIDER #31

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This program 532-34077 is approved by the AAVSB RACE to offer a total of 257.00 CE Credits (27.00 max) being available to any one veterinarian: and/or 134.00 Veterinary Technician CE Credits (18.00 max). This RACE approval is for the subject matter categories of: Category One: Scientific; Catgory Two: Non-Scientific-Clinical; Category Three: Non-Scientific-Practice Management/Professional Development using the delivery method of Seminar/LectureLab/Wet Lab. This approval is valid in jurisdictions which recognize AAVSB RACE; however, participants are responsible for ascertaining each board's CE requirements. RACE does not "accredit" or "endorse" or "certify" any program or person, nor does RACE approval validate the content of the program.

Join us for the 6th Annual Gulf-A

Wet lab & Work

DENTISTRY FELINE EXTRACTION TECHNIQUES Thursday | 8:00 a.m. - 12:00 p.m.

Jan Bellows, DVM, DAVDC, DABVP | David Bellows, DVM

SURGERY AV LI AI MIT LA ED BI LIT Y

Thursday | 8:00 a.m. - 5:00 p.m.

Howard B. Seim III, DVM, DACVS Clara Goh, BVSc, MS, DACVS-SA, ACVS

CANINE EXTRACTION TECHNIQUES Thursday | 1:30 p.m. - 5:30 p.m.

Jan Bellows, DVM, DAVDC, DABVP | David Bellows, DVM

ADVANCED DENTAL Friday | 8:00 a.m. - 12:00 p.m.

Jan Bellows, DVM, DAVDC, DABVP | David Bellows, DVM

DENTAL RADIOLOGY POSITIONING AND TECHNIQUES Friday | 1:30 p.m. - 5:30 p.m.

Denise Rollings, CVT, VTS (Dentistry)

DENTAL PROPHYLAXIS Saturday | 8:00 a.m. - 12:00 p.m.

Denise Rollings, CVT, VTS (Dentistry)

PRACTICAL TECHNIQUES IN CANINE SOFT TISSUE SURGERY

OPHTHALMIC SURGERY AV LI AI MIT LA ED BI LIT Y

Thursday | 10:00 a.m. - 5:00 p.m.

Robert Swinger, DVM, DACVO

ULTRAS AV LI AI MIT LA ED BI LIT Y

BASIC SMALL ANIMAL A ULTRASOUND - NORMALS

Thursday | 8:00 a.m. - 5:00 p Jason Arble, DVM, MSc, DACVR, MRCV

ADVANCED SMALL AN ABDOMINAL ULTRASOU

Friday | 8:00 a.m. - 5:00 p.m Jason Arble, DVM, MSc, DACVR, MRCV

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ANNE DVM

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■ JIM ARNOLD ■ DR. AMY BAKER ■ DR. DAVID BELLOWS ■ MEGAN BRASHEAR ■ DR. DYLAN BUSS ■ DR. SUSAN CARASTRO ■ DR. PAIGE EVANS ■ DR. CLARA GOH ■ MARY HARRISON ■ DR. DANI MCVETY ■ MICHELLE MCCONNELL ■ DR. JESSICA PRITCHARD ■ DENISE ROLLINGS ■ DR. MASON SAVAGE ■ DR. HEIDI WARD

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56

th

ANNUAL OCALA

EQUINE CONFERENCE

FEBRUARY 1-3, 2019 | OCALA, FLORIDA

SAVE THE DATE | FEBRUARY 1-3, 2019 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.

COMPREHENSIVE EQUINE ULTRASOUND WET LAB

February 1 | 8:15 a.m. - 4:30 p.m.

Full program coming soon!

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This is an exciting opportunity for equine veterinarians to gather in “The Horse Capital of the World” for a world-class program of wet lab and lectures presented by acclaimed equine medicine experts.

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patients have decreased baroreceptor activity, blood volume, cardiac output, blood pressure, circulation time and vagotonia.

The conduction system of the heart is also affected by aging. In human geriatric patients, left bundle branch block, intraventricular conduction delay, ST segment and T wave changes, and atrial fibrillation are commonly noted. These may make the older patient more prone to anesthetic-induced cardiac dysrhythmias.

Progressive and degenerative myocardial disease is increasingly likely in geriatric patients. This is usually associated with chronic valvular disease, which can lead to increased myocardial work and oxygen consumption and demand and make the myocardium extremely sensitive to hypoxia.

Geriatric patients often develop thickened elastic fibers and an increase in collagen and calcium in the walls of large arteries, which results in increased peripheral resistance. The ability of the geriatric patient’s cardiovascular system to adapt to hypotension is limited, and autoregulation is decreased.

Pulmonary Changes

Respiratory function progressively diminishes as a patient ages, resulting in a decreased functional reserve. There is a loss of strength in the muscles of respiration, chest wall compliance decreases, and there is a loss of elastic recoil.5 These changes result in an increase in small airway closure, which produces a decrease in vital capacity and an increase in residual volume. There is a decrease in lung elasticity, respiratory rate, tidal volume, minute volume, oxygen consumption, carbon dioxide production, maximal diffusion capacity for oxygen capillary blood volume and protective airway reflexes in the aged patient. With agerelated increase in closing volume, greater portions of tidal ventilation occur at lung volumes below closing volume, causing air trapping, worsened ventilation/perfusion mismatch and decreased resting PaO2. A decrease in protective pharyngeal and

laryngeal airway reflexes puts the geriatric patient at increased risk of aspiration in the perioperative period.6 Anatomic dead space and functional residual capacity are increased with age.

Furthermore, human geriatric patients have a marked reduction in their ability to respond to induced hypercarbia and hypoxia.

Geriatric changes in the respiratory system are significant in that even mild to moderate respiratory depression resulting from anesthesia may produce marked hypoxia and hypercarbia, and any pathological disease of the respiratory system (e.g. pneumonia, edema, pulmonary fibrosis) will be greatly exacerbated in the geriatric patient. What is considered mild anesthetic depression in the young patient may be disaster in the aged patient.

Hepatic System

With increasing age, there is a reduction in the functional state of the hepatic microsomal enzyme system. This reduction is present even when the standard biochemical function tests are normal.7 Geriatric patients often have decreased hepatic blood flow, primarily as a result of decreased cardiac output.

The plasma half-life of drugs dependent on hepatic excretion, metabolism or conjugation is often thereby increased in the geriatric patient. Altered hepatic function in the aged patient also may lead to hypoproteinemia, impaired clotting functions and a greater susceptibility to hypoglycemia.

Renal System

Renal function may be greatly impaired in geriatric animals. This impaired renal function may have marked significance since the kidney is the major effective organ for fluid and electrolyte balance.

Separate from disease processes, normal aging alters renal function in several ways. Renal blood flow is decreased, most likely as a result of reduced cardiac output. There is a decrease in the total number of glomeruli to one half to two-thirds of that in the young patient, and the nephron mass is WWW.FVMA.ORG |

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Central Nervous System

Aging produces changes in the central nervous system in human and animal patients. There are alterations in cognitive, sensory, motor and autonomic functions. Cerebral perfusion and oxygen consumption decline. Aging is also associated with a reduction in brain weight, which is most likely a result of individual neuron degeneration. The loss of brain weight is most evident in the cerebral cortex and the cerebellar cortex. Myelin sheaths also degenerate in the aged patient.

There is strong evidence that neurotransmitters change with age, with increased destruction and decreased production of neurotransmitters in the geriatric patient. The reduction in neurotransmitter function may be a result of the decreased quantity of neurotransmitters or a change in the receptors themselves.

Photo courtesy of Dr. Ralph Harvey

The overall effects of these central nervous system alterations on anesthetic management of the geriatric patient are not fully understood. The effects of local anesthetic agents seem to be enhanced in the aged patient, and the effects of neuromuscular blocking agents are prolonged. In addition, thermoregulatory center function is decreased, making the geriatric patient more susceptible to anesthesia-induced hypothermia.

Autonomic Nervous System

reduced. Tubular changes occur, including atrophy, decreased tubular diameter, tubular disruption and tubular hypertrophy.

Glomerular filtration rate may be reduced by 50 percent, and there is a decreased ability to concentrate urine and excrete hydrogen ion because of decreased function of the distal tubules.

The urine volume necessary for excretion of the obligatory solute load increases. Antidiuretic hormone increases with aging due to increased resistance of the distal renal tubules to its effects. This change can result in impaired renal concentrating ability The result of these changes is a diminished functional renal reserve, which makes the geriatric patient much less tolerant of body water deficits or excessive administration of fluids. Older patients have a decreased capacity to excrete certain drugs and are more prone to acidosis, thus prolonging the plasma half-life of drugs dependent on renal excretion The effects of anesthesia and surgery on the kidney can be greatly exacerbated in the geriatric patient. Anesthesia and surgery commonly cause increased activity of the sympathetic nervous system and of the renin-angiotensin system, resulting in decreased total renal blood flow and a redistribution of intrarenal blood flow away from the renal cortex. General anesthesia may decrease renal blood flow and glomerular filtration by up to 40 percent. Anesthesia and surgery also may cause hypovolemia, hypotension, hypoxia and hypercarbia, all of which compound any preexisting renal dysfunction. These factors contribute to make the geriatric patient much more susceptible to renal failure following anesthesia and surgery.

22  |  FVMA ADVOCATE

The autonomic nervous system loses some of its ability to respond to stress in the human geriatric patient. This appears to be most marked in the sympathetic nervous system. The aged patient has decreased vasoconstrictor responses and a decreased response to decreased cardiac preload.8 Despite this reduced response, there appears to be an enhanced response to iatrogenic epinephrine and norepinephrine, thus leading to the conclusion that perhaps the autonomic nervous system output is decreased but the receptors are more sensitive.

Endocrine System

Although aging does not appear to alter adrenocorticotropic hormone (ACTH)-stimulated plasma cortisol levels, there are reports that human geriatric patients may not have the adrenal gland reserves necessary to protect themselves adequately during stress from anesthesia and surgery. Renin and aldosterone hormones, which are necessary for water, sodium and potassium balance as well as blood pressure control, are attenuated when the human geriatric patient is stressed.9 Thereby, the geriatric patient is more susceptible to hypotension. Various endocrine diseases are more common in the aged patient, contributing to cardiac dysfunction, impaired thermogenesis and ventilation, impaired metabolic elimination of anesthetics and delayed recovery from anesthesia.

The first part of this series covered the physiological changes associated with anesthesia use with senior pets, and the next article in the series will focus on reviewing age-related changes in the distribution of anesthetic and preanesthetic drugs in the geriatric patient as it relates to anesthesia.

References

1. Holmstrom SE, Bellows J, Juriga S, Knutson K, Niemiec BA, and Perrone J. 2013 AAHA Dental Care Guidelines for Dogs and Cats. Journal of the American Animal Hospital Association 2013; 499(2): 75-82.

2. Harvey RC, Paddleford RR. Management of geriatric patients: a common occurrence. Vet Clin North Am Small Anim Pract 1999; 29(3):683-699.

3. Baetge CL, Matthews NS. Anesthesia and analgesia for geriatric veterinary patients. Vet Clin North Am Small Anim Pract. 2012;42(4):643-53.

4. Burns P. Top 5 Considerations for Anesthesia of a Geriatric Patient. Clinicians Brief 2015;71-75.

5. Knudson RJ, Clark DF, Kennedy TC, et al., Effect of aging alone on mechanical properties of the normal adult lung. J Appl Physiol 43:1054-1062, 1997.

6. Pontoppidan H, Beecher HK: Progressive loss of protective reflexes in the airway with the advance of age. JAMA 174:2209-2213, 1960.

7. Green DJ, Sellers EM, Shader RI: Drug disposition in old age.

N Engl J Med 306:1981-1988, 1982.

8. Collins KJ, Exton-Smith AN, James MH, et al,: Functional changes in autonomic nervous system responses with aging.

Age Ageing 9:17-24, 1980.

9. Weidman P, DeMyttenoere-Buraztein S: Effect of aging on plasma renin and aldosterone in normal man, Kidney Int 8:325-333, 1975.

Ralph Harvey, DVM, MS, DACVAA

Dr. Ralph Harvey teaches anesthesia and pain management in the Department of Small Animal Clinical Sciences at the University of Tennessee College of Veterinary Medicine (UTCVM) in Knoxville, Tennessee. He previously served as the section head for the Small Animal Surgical Services and is a member of the University Faculty Senate. His veterinary degree is from the UTCVM and his post-graduate training includes an internship, residency and fellowship at Cornell's Veterinary and Medical Colleges.

Dr. Harvey has worked in private small animal practice. He is certified as a specialist by the American College of Veterinary Anesthesia and Analgesia, and he has served as their executive secretary and as a member of the ACVAA Board of Directors.

He is currently a member of the Fear-Free Advisory Panel and Executive Council.

He has received the UT Brandy Memorial Award, the Outstanding Faculty Member Award from the Tennessee Veterinary Medical Association, and the UTCVM Outstanding Alumni Non-Practice Career Award.

His community service has included work with regional science fair programs, Explorer Scouting, the Leukemia/Lymphoma Society, and with wilderness and conservation groups.

Should the Real Estate be Sold with the Practice?

DOYLE WATSON, DVM | PRESIDENT, SIMMONS & ASSOCIATES

This question commonly arises in practice sales with combined real estate ownership. Many owners do not think they should sell or can sell the real estate with the practice. We hear the following reasons: 1. I want the rental income.

2. I want the future growth investment to sell later at a higher price.

3. I want to defer taxes by not paying on the entire sale at once.

4. I want to sell later once I am sure the practice sale is secure.

5. No one can afford to buy it all now.

The first three reasons can all be solved by a 1031 exchange.

Although there are rules to follow, and your CPA and attorney will need to be involved, the beauty of the 1031 is that one can exchange “like kind” properties and defer the taxes on the gain from the sale. As to income production and growth in value, the 1031 can provide these attributes of the old property to the new property - maybe even better. As to future investment, veterinary practice real estate has limited use and is probably not as good of an investment as perhaps another piece of property nearby (or anywhere in the USA) with a broader use. Moreover, the gain above the original cost basis on the real estate sale is taxed as a capital gain. Unless there is a change in our tax structure, capital 24 | FVMA ADVOCATE

gain income tax will always be with us and maybe at a higher rate.

So why not take a 1031 exchange now and roll over the real estate ownership into a more desirable, income-producing and growth property? This would defer the taxes and more effectively achieve the same investment goal of income-producing and growth property ownership.

As to reason No. 4, one of the reasons that commercial lenders are so eager to make practice loans to veterinarians is that the loans “simply do not go bad”, as one lender reported. In our experience, the great majority of practices make a strong increase in revenues the first 12 months after purchase. Combine these favorable statistics with the seller’s own intuition as to whether the buyer can follow in the seller’s footsteps and be accepted by the staff and clientele, and the long-term results following the sale are excellent. So after-sale security is not a valid reason to hold onto the real estate.

Probably the greatest fallacy is No. 5, “that the buyer can’t afford to buy it all now.” While this was true a few decades ago, it simply is not today. There are many commercial veterinary practice acquisition lenders who are very aggressive in our profession.

So loan funds are readily available for buyers to purchase the real estate along with the practice. These typically come with a very small or token down payment (maybe approaching $0) and favorable rates and terms. At today’s terms, the mortgage payment on the real estate is typically less than a rent payment would be assuming you would charge fair market rent if you kept it.

Notwithstanding all above, a major reason to consider selling the real estate with the practice is simply to accomplish the sale.

Most private buyers (versus corporate) who are interested in purchasing the practice will insist on including the real estate for the following reasons: 1. Fair market rent payments are probably greater than a mortgage payment.

2. To begin building equity in real estate and increase net worth.

3. To avoid dealing with a landlord.

4. It does not require any more down payment when real estate is included.

We have seen transactions fall through when the seller refused to sell the real estate.

Another reason to sell the real estate vs. renting is the consideration that the tenant may decide later not to renew the lease but relocate the practice. This would create a vacancy with the probability that no other veterinarian could become a tenant.

If a veterinary practice is the highest and best use, the real estate could then become less valuable.

As to terms of the real estate sale, the commercial lenders will typically lend 80% of the real estate value with the balance financed through a note to the owner (since most buyers seldom have a 20% injection available), which can have a long-term amortization period with a short term balloon payment.

Doyle Watson, DVM President & Owner Simmons & Associates Southeast, Inc.

6th Annual Simmons Seaside Seminar Practice Management & Ownership Conference

Secure your spot for this boutique event where we combine learning with fun!

JEKYLL ISLAND CLUB HOTEL Jekyll Island, GA SEPTEMBER 20-22, 2018

Feature Speakers Byron Farquer, DVM, CVA Louise Dunn Mary Ann Van de Linde, DVM

website http://simmonsinc.com/veterinary-practice-management-conference/ Call (800) 333-1984, email seasideseminar@simmonsinc.com for details

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PRACTICE GOT A QUESTION? THE FVMA CAN HELP. One of the benefits of membership in the FVMA is our Helpline, 800.992.3862, available to members daily, Monday to Friday, 8:00 a.m. to 6:00 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, in an effort to keep our members up-to-date on current concerns as well as regulatory and legislative changes.

QUESTION:

I work at an emergency veterinary clinic in Florida with three vets on staff. We are open nights, holidays and weekends. They have asked me to find out what the rules are on "firing" an irate client who has verbally threatened our staff. I have looked at the statutes, I can’t find where it is located in them. We have been told that we cannot refuse to see someone because we are an emergency clinic, but one of our doctors says that if there is an emergency clinic within two hours of us we legally can. There are two emergency clinics within an hour to two hours from us.

A: There are no laws or rules on this issue. Even if you are the only veterinary clinic within a two hour radius, if a client becomes belligerent and threatens staff you have the absolute right to fire or discharge a client. You have to do it in a way that does not create an immediate problem with the health/safety of the patient. So, you can't fire the client when he shows up at 3 a.m. in an emergency. That would constitute patient abandonment. Instead, you must send the client a certified letter that states that the clinic will be unable to provide any future services. You don't have to give a reason. Offer to provide patient records and give the information regarding the closest emergency clinic. It could be as simple as: "We regret to provide this formal notice that we will be unable to provide any future veterinary services to you. We are ready to provide you (or the veterinarian you designate) with copies of any patient records we have generated. In the event of any future veterinary emergency, we recommend that you contact the XYZ Clinic at (address) and (phone number)."

QUESTION:

I was trying to look up info for my doctors on what technicians can legally do in Florida, but I can only find the basics such as no surgery, diagnosis or prescribing. I can't find details such as euthanasia, rabies vaccine, minor extractions, skin sutures, etc. that vary by state. Can you please send me what the limits and allowances of our licensure is?

A: There is no rule that lists which tasks can or cannot be delegated. Instead, there is a rule on tasks which require

26 | FVMA ADVOCATE

immediate supervision, and it basically states that everything must be under immediate supervision except for (a) and (b) in the rule.

The chapters that address this are: CHAPTER 61G18-17 EXEMPTIONS AND EXCEPTIONS 61G18-17.001 Exemptions and Exceptions (Repealed) 61G18-17.005 Tasks Requiring Immediate Supervision 61G18-17.006 Diseases which Only a Veterinarian May Immunize or Treat 61G18-17.001 Exemptions and Exceptions.

Specific Authority 474.203, 474.206 FS. Law Implemented 474.202(9), 474.203(5) FS. History–New 7-9-80, Formerly 21X17.01, 21X-17.001, Amended 7-4-95, 1-5-98, 3-6-06, Repealed 1-31-07 .

61G18-17.005 Tasks Requiring Immediate Supervision.

(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 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 61G1817.006, F.A.C., requires “immediate supervision” as that phrase is defined in subsection 474.202(5), F.S.

Specific Authority 474.203(7), 474.206 FS. Law Implemented 474.203(7) FS. History–New 10-17-85, Formerly 21X-17.05, 21X17.005, Amended 5-27-03.

61G18-17.006 Diseases which Only a Veterinarian May Immunize or Treat.

For the purpose of implementing the exemption provisions of subsection 474.203(4), F.S., the Board recognizes that the following diseases are communicable to humans and are of public health significance, and that only a veterinarian may immunize or treat an animal for these diseases: (1) Brucellosis.

(2) Tuberculosis.

(3) Rabies.

(4) Equine Encephalomyelitis.

Specific Authority 474.206 FS. Law Implemented 474.203(4) FS. History–New 10-17-85, Formerly 21X-17.06, 21X-17.006.

QUESTION:

If a veterinarian does NOT have a VCPR with a patient but another doctor in the hospital does, can the veterinarian legally prescribe medication for this patient even though they have NEVER seen the patient before? We are having a difference of opinions at my hospital and needs clarification.

A: If the Vet has access to the patient's records, can check to see that the medication is indicated and that whatever necessary tests have been completed, then the Vet can authorize/ prescribe a REFILL of the medication the patient is already on.

A Vet can't prescribe the INITIAL prescription for a patient he/ she has never examined, or a patient he/she has not recently seen or otherwise be familiar with. The statute provides that a Vet can be disciplined for: (y) Using the privilege of ordering, prescribing, or making available medicinal drugs or drugs as defined in chapter 465, or controlled substances as defined in chapter 893, for use other than for the specific treatment of animal patients for which there is a documented veterinarian/client/patient relationship. Pursuant thereto, the veterinarian shall: 1. Have sufficient knowledge of the animal to initiate at least a general or preliminary diagnosis of the medical condition of the animal, which means that the veterinarian is personally acquainted with the keeping and caring of the animal and has recently seen the animal or has made medically appropriate and timely visits to the premises where the animal is kept.

2. Be available or provide for follow up care and treatment in case of adverse reactions or failure of the regimen of therapy.

3. Maintain records which document patient visits, diagnosis, treatment, and other relevant information required under this chapter.

In the case of a Vet in the same practice with access to the records, the Vet is "personally acquainted with the keeping and caring of the animal."

QUESTION:

I have a patient (canine) who is currently under the emergency care of another hospital. It is an abuse situation that now involves law enforcement and an arrest has been made. The hospital in question requested medical records at the end of the workday yesterday for the past couple of years. I have emailed the owner requesting consent, and by telephone this morning asked him to respond to my email as soon as possible.

Question: Can medical records for "the past couple of years" be released under section 474.2165 of Florida Statutes since the pet is in the current medical care of the requesting hospital facility without owner consent?

A: You can share records with other veterinarians involved in the care or treatment of the patient. No client authorization is necessary. See the exemption below in section 474.2165, Fla. Stat.: Ownership and control of veterinary medical patient records; report or copies of records to be furnished.— (5) Except in a medical negligence action or administrative proceeding when a veterinarian is or reasonably expects to be named as a defendant, information disclosed to a veterinarian by a client in the course of the care and treatment of the patient is confidential and may be disclosed only to other veterinarians involved in the care or treatment of the patient, or if permitted by written authorization from the client or compelled by subpoena at a deposition, evidentiary hearing, or trial for which proper notice has been given.

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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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98% s Succes

Cat Thyroid Center

Rate

Treating Feline Hyperthyroidism

717 S. TAMIAMI TRAIL, RUSKIN, FL 33570 813.641.3425 | WWW.CATTHYROID.COM “Dr. Ott and his team are true professionals who always go above and beyond in the care of both the patient and the patient’s people. The Cat Thyroid Center has treated two of my family members and both of these demanding ladies had absolutely no complaints at the level of service and attention they received during their I-131 spa treatment.”

– Dr. William Walsh, A Pet’s Friend Animal Hospital, Venice, FL

“Over the years I have referred literally dozens of hyperthyroid cats to the Cat Thyroid Center. Every client I have sent has been very impressed and happy with the service they and their pet has received. The feedback I get is always positive, and I will continue to refer my clients to Dr. Ott for I-131 treatment.”

– Dr. Andrew King, Cat Hospital of Sarasota, Sarasota, FL

“The Cat Thyroid Center offers excellent medical care and makes sure the patient and client feel at home. Dr. Ott does an amazing job following up with cases both with the owners and with me. He is always available when any questions arise. His compassion and knowledge make the Cat Thyroid Center superior when it comes to treatment and as a result we highly recommend him.”

– Dr. Sherri Basso, Pine Castle Animal Care Center, Orlando, FL

28 | FVMA ADVOCATE

 Specialized Treatment in a Warm, Home like Environment.  Focus on Customer Service Excellence with Individualized Patient Care.  Over 20 Years of Experience.  Short, 48 Hour Stay.

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CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED

VETERINARIAN WANTED – THE VILLAGES, FL: Animal Hospital in The Villages, FL is seeking an enthusiastic associate veterinarian to join our team. We are ideally looking for a full time veterinarian, but will consider part time. Our practice is an AAHA accredited small animal hospital that is fully equipped, including a great support staff. We are also Villages Charter School eligible. Please contact us by email at pawsah@embarqmail.com. (4/18; ID#28224) VETERINARIAN WANTED – JACKSONVILLE, FL: Jacksonville, 3 doctor, small animal practice seeking a doctor. Complete lab, digital xray, fluid pumps, tonopen etc. Good general medicine/surgical care. LVT’s. Salary negotiable. Vacation, CE, insurance etc. Flex schedule with no ER call. Please contact Rebecca vetnet5@aol.com or 877-838-6384. (4/18; ID#28143) VETERINARIAN WANTED – POLK COUNTY, FL: Full Time Veterinarian – Competitive Salary and great benefits. $87,726 - $100,668 Are you looking to make a difference? Then come join our team at Polk County Sheriff's Office. The Animal Control Veterinarian plans, organizes and oversees the activities of the veterinarian services within the Animal Control section. The member performs all surgical and medical procedures necessary for the overall health of animals maintained by the Sheriff’s Office and reports to the Animal Control Administrator. To learn more about this exciting opportunity visit our website at www.polksheriff.org and click on Become a Member. (4/18; ID#7436) VETERINARIAN WANTED - SEBRING, FL: Well established, growing small animal practice in Sebring FL seeking associate veterinarian. No after hours emergencies. New graduates considered. Competitive salary. Please visit oakhammockah.com for more information about our practice. Please submit resume and CV to employment@oakhammockah.com. (4/18; ID#26619) VETERINARIAN WANTED – STUART, FL: Join three veterinarians as part of our positive and collaborative team in our modern free-standing 6,000 sq ft All Creatures Animal Hospital in Stuart, FL (east coast of FL north of Palm Beach). Full time is preferred but part time willing to work Saturdays would be considered. Our hours are 8 am- 6 pm Mon-Sat so a 4-day work week is considered full time. We are currently 95% canine and feline and 5% exotics; interest in exotics is welcome but not required. Please send resumes to bressmananimalhospital@hotmail.com. (4/18; ID#26911) FULL-TIME VETERINARIAN WANTED – NAPLES, FL: Gulfshore Animal Hospital, an AAHA 3 doctor practice in beautiful Naples, FL, is seeking a full-time associate to fill our third doctor vacancy. Established in 1971, Dr. David Ball and Dr. Kim Schemmer have owned Gulfshore Animal Hospital since 1987. We have a 4350 sq. ft. hospital and boarding facility located on the main highway in central Naples. Our practice is computerized with the most current ImproMed software, capable of paperless medical record keeping. Our practice is equipped with the latest technology including digital dental radiology, laser surgery, K-Laser therapy, Sound digital radiology, Idexx in-house laboratory equipment, and a GE laptop ultrasound. We have an exceptional clientele who demand, and can afford, quality comprehensive veterinary care. Our practice is committed to attention to detail and exceptional client communication and service. We have an excellent management team composed of the current owners and a practice manager of 15 years who are committed to a team approach to the practice of veterinary medicine. This management team is prepared to and capable of training the new associate in the management procedures and practices that have contributed to this very successful practice over the years.

The candidate must have leadership skills, share the approach to veterinary medicine described above. This is a tremendous opportunity for the right individual. Our practice address is 3560 Tamiami Trail North, Naples, FL 34103 and our website is www.gulfshoreanimalhospital.com.

Interested candidates should email a letter of introduction and current resume to drdave@gulfshoreanimalhospital.com. (4/18; ID#26066)

VETERINARIAN WANTED - FLORIDA: Mobile Euthanasia Veterinarian - Tampa. Florida Home Euthanasia is adding compassionate veterinarians to our growing team of home euthanasia providers in the greater Tampa area.

We help pets and their families say goodbye in the comfort of home. Enjoy 1-hour visits with each client, minimal record-keeping, and no financial discussions, all expertly supported by our scheduling team. Flexible, parttime schedule (full-time potential), generous benefits, extensive training, no on-call or overnights, and management opportunities. Openings in Tampa/ St. Pete, Sarasota, Fort Myers, Naples, Jacksonville and West Palm Beach to Ft. Lauderdale. To learn more, visit www.dvmcenter.com and contact Dr. Heather at careers@dvmcenter.com. (4/18; ID#10622) ASSOCIATE POSITION FOR SARASOTA FLORIDA SMALL ANIMAL VETERINARY PRIVATE PRACTICE: Be part of a great team in this well-established veterinary hospital. Our friendly and fun support staff will lead your way to building a dedicated practice following. This growing practice has a great reputation in the community and is expanding in 2018.

Generous salary, schedule and benefits package including 401k with profit sharing plan. Part time and Full time opportunities available. Contact: drsmall@flacsrq.com (4/18; ID#26131) ASSOCIATE VETERINARIAN WANTED – CLEARWATER, FL: Well established 30 year small animal and exotic practice in Clearwater, Florida is seeking to find a 3rd veterinarian to add to our family. Many of our employees have been with our hospital 20-25 years. We love what we do: give our patients excellent care with the latest in digital radiology, ultrasound, surgical CO2 laser, low level therapeutic laser, and thermal imaging. We deal in all species of animals. You don’t have to know it all, just be willing to learn. We have a very high paced clinic so it will never be boring. Check us out at www.myanimalandbird. com. 2 years minimum of experience needed. Email resume to kwhite@myanimalandbird.com (4/18: ID#15796) VETERINARIAN WANTED – CENTRAL, FL: Northgate Animal Clinic is seeking a full or part-time associate veterinarian. We are a busy, small animal practice located in the Central, FL area (close to the Villages and Orlando). We enjoy a small-town atmosphere and strive hard to maintain a strong client and patient relationship.

Our clinic is equipped with Sound Eklin digital radiography, Class IV therapy laser, full in-house Abaxis diagnostics, fully stocked pharmacy, and trained support staff. Some of our services include dentistry, soft tissue surgery, limited orthopedic surgeries, full boarding and bathing, wellness care and immunizations. Our hours of operation are Monday through Friday 8:00 am – 6:30pm. We refer after hours emergencies to the local emergency clinic. Salary will be competitive along with a benefits package and long-term employment for the right person.

Please email resume to our practice manger, Beth Thomas at bethsthomas@gmail.com. (4/18: ID#26877) VETERINARIAN WANTED – NAPLES, FL: Angel Animal Hospital & Boarding (2017 voted #1 Vet in SWFL) is growing and looking to add to our already incredible team. We’re seeking an associate veterinarian for a full time or near full time position. We operate in a 10,000 sf stand alone premium space with all the latest equipment available to the industry.

Health insurance, 3% matching IRA, CE days and allowance, remote access from home to your computer and other competitive benefits included with employment. Please send a cover letter and resume to gavin@angelanimal.vet for consideration to start your new opportunity in gorgeous Naples, FL. (4/18; #2888) VETERINARIAN WANTED – OVIEDO, FL: Oviedo Veterinary Care and Emergency is seeking a full-time or part-time veterinarian to work at our small animal practice located in Oviedo, FL. We are in a busy and rapidly growing part of Seminole County, in the heart of central Florida. We are passionate about making our practice an integral part of our community by providing high-quality veterinary care for our patients, and exceptional customer service for our clients. We

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are looking for someone equally passionate and motivated to join our progressive, forward-thinking team.

We offer continuous patient care with conveniently extended hours of operation and weekend service, allowing for flexible schedules! We offer a fully equipped in-house lab, digital radiography, a comprehensive surgical suite, and cloud-based software with digital record-keeping.

Potential applicants should be comfortable handling critical cases and emergencies, as well as emphasize the importance of preventative care.

Please contact by email at info@oviedovetcare.com. New graduates welcome to apply! (4/18: ID#381) VETERINARIAN WANTED – COLLIER COUNTY, FL: Salary Range$90,834 – $112,331 Collier County Domestic Animal Services is seeking an experienced and highly reliable Shelter Veterinarian to join our organization. This professional position will provide medical and surgical care and treatment for animals at the shelter while educating the staff and the community in the care of animals. Work is performed under the general supervision of the Division Director of Animal Services with considerable independent judgment and initiative in carrying out daily operations. For additional information or to apply, please visit www.colliergov.net/jobs (4/18: ID#2077) ASSOCIATE VETERINARIAN WANTED – SUNNY VENICE, FLORIDA: Amazing Opportunity available for a Associate Veterinarian To join the team at A Pet’s Friend Animal Hospital.

A Pet’s Friend is an Award Winning Small Animal Practice, located in beautiful Southwest Florida. We have an excellent reputation within our community and are privileged to serve clients who truly value the Human/Animal Bond. Our Support Staff is highly skilled and selfmotivating. Practice owner and the Support Staff are excited about the opportunity to add an experienced, full/part time, career minded veterinarian to our team.

Applicants looking for ownership opportunities will be given higher priorit y. Competitive compensation and benefits based on experience. Associate interested in ownership opportunities contact William A. Walsh, Jr. DVM via email to: apetsfriendanimalhospital@verizon.net. (4/18: ID#5426) OVERNIGHT VETERINARIAN WANTED - LOXAHATCHEE, FL: Looking for an Overnight Veterinarian to add to our busy small animal practice. 1-4 nights available, we are very flexible. Proof of FL License required. Our practice is well established. Offering competitive Salaries & Health Insurance benefits. We provide Digital X-Rays and in-house labs with IDEXX. Located in palm beach county. Please contact Dr. Ira Grossman at Mgross1007@yahoo.com. (4/18: ID#1510) VETERINARIAN WANTED – TEQUESTA, FL: AAHA practice in affluent coastal south Florida community looking for full time 2nd doctor. We have digital X-ray and digital dental X-ray, therapeutic laser, ultrasound, amazing vet staff, even more amazing clientele. There are 2 emergency clinics within 7 miles, so there is minimal after hours care.

Tequesta, Florida is nestled within Jupiter in the north end of Palm Beach County. We’d like someone with at least a few years of experience, confidence, and most of all a charming upbeat personality. Strong medicine skills a must. Bonus points if you also have good surgical skills.

Call Dr Sutton at 561-914-6403 or email joisuttondvm@yahoo.com.

Our website is tequestaveterinaryclinic.com. Tequesta is home to Jupiter Island. Our clientele expects nothing but the best. It is a pleasure working in such a beautiful community where clients can afford proper care for their pets. The clinic is 5 minutes from the beach.

We may help with relocation costs for the right applicant. Our clinic is a pearl, and we want another strong spectacular doctor. (4/18: ID#8931) VETERINARIAN WANTED – CLEARWATER, FL: Well-established small animal practice located on the west coast, looking for a full-time veterinarian. We provide full-service medical, dental, and soft tissue surgical procedures. We have in-house IDEXX vet lab stations, digital radiography, ultrasonic dental equipment. NO after-hour/emergency shifts. Great supportive staff, competitive salary. Benefits include: Insurance, 401-K, 2 weeks PTO, and CE.Please contact via email at eah34219@aol.com(4/18: ID#28303)

RELIEF VETERINARIAN

RELIEF VETERINARIAN WANTED – ORANGE PARK, FL: Relief Veterinarian wanted part time, one day a week and half day on some Saturdays in Orange Park, Florida for Clay County Animal Hospital.

Please call Sheila at 904-272-5111. (4/18: ID#17402) RELIEF VETERINARIAN WANTED – APOLLO BEACH, FL: Relief Veterinarian wanted part time, Fridays ( full day), and Saturday (8-12 noon); or Saturdays only if no availability on Fridays; we are a one doctor AAHA accredited practice in Apollo Beach, FL; please contact Dr. Sierra at sierraanimalhospital@gmail.com, and visit our website www.sierraah.com (4/18: ID#1035)

PRACTICES FOR SALE OR LEASE

EQUIPMENT FOR SALE – ST. PETE, FL: I have 3 top of the line surgical microscopes to sell, and I will sell 2/3; the 3rd I will be keeping for my own clinic. Your pick $3950 each: Leica M690 X-G, Zeiss MD, Zeiss OPMI 1-FC. 727-492-1831 I have several BCI 3303 Pulse Oximeters, with new batteries and tongue transducer. Other transducers may be purchased for them. I personally use one of theses in my clinic every day. $195.00 each 727-492-1831 Veterinary equipment for entire vet clinic available. Bring your truck! anesthesia surgery x-ray digital complete lab with Scil/Schein etc. Digital x-ray; complete modern lab; cages; exam; prep; and surgery room and so much more. So many items that it should give you nearly all you need.

I have hundreds of pictures of equipment and furnishings that will be included in this lot. We have increased the amount of equipment in this sale substantially in the last month. It includes high quality equipment hard to find on the secondary market and for a great lot sale price. We will only as a whole package– no break up. Ready to go. This package will not last $58,000. Please contact me for more information. Dr C. 727-492-1831. (4/18; ID #1410)

We buy great practices.

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20 YEARS

It’s been a great 20 years. Want to join the celebration?

Over 260 practices in 28 states and growing. acquisitions: acq@vetcor.com • jobs: careers@vetcor.com

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Sale

Florida & Georgia Practices for Sale

doctor (FL28A)

FL: NEW! Central FL: $624K+ gross, solo doctor practice. No emergencies, 5 day work week. (FL28A)

mal, solo

FL: North Miami: $766K+ gross, small animal, solo doctor practice. Leased facility. (FL60M)

ears, small ng Sale

FL: Jacksonville Area: $1M+ gross, 36+ years, small animal, solo doctor practice. (FL25J) Pending Sale

15% in

GA: South Central GA: $818K+ gross, up 15% in 2017, 1.5 doctor practice. (GA14F)

hether listing, or ractice rcial Watson at nonmative and ary practice we have ommon-

PRACTICE OWNERS…now is the time to sell! Whether you’re pondering an associate sale, open market listing, or corporate sale, Simmons will help! The current practice sales market is dynamic with buyers, and commercial financing is readily available. Contact Dr. Doyle Watson at Simmons Southeast today, for a complimentary, nonobligatory consultation. The dialogue will be informative and time well spent. As the original pioneer of veterinary practice brokerage, we have been at this since 1977, so we have seen a lot. Let our knowledge, experience, and commonsense business judgment work for you.

GA 31522 nc.com m olina, er

Sale

doctor (FL28A)

1610 Frederica Road, Saint Simons Island, GA 31522 Toll Free: (800) 333-1984 | www.simmonsinc.com Email: southeast@simmonsinc.com Licensed in Florida, Georgia, North Carolina, and South Carolina Real Estate Broker

Florida & Georgia Practices for Sale FL: NEW! Central FL: Practice $624K+ Listings! gross, solo doctor Florida practice. No emergencies, 5 day work week. (FL28A)

Sold-North Florida– Solo Dr. small animal, 2017 gross $905k, Well new $766K+ digital X-ray.

High net...

FL:established, North Miami: gross, small animal, solo Sold-Central Fl.– Leased 2 Dr. Practice with 2017 gross of $1.5mm+. doctor practice. facility.

(FL60M) 2500 sq. ft. office with 2800 sq.ft. pet resort.

Sold-Sarasota County– 1.5 Dr. Practice 2017 gross about ears, small $730K. FL: Jacksonville $1M+ gross, 36+ years, small Free standing Area: office on major 4 lane.

Booming area. ng Sale animal,Fl.– soloSolo doctor practice.

(FL25J) Pending Salepriced Central Dr. Practice with 2017 gross of $860k to sell. Established for about 40 years with great reputation.

Central Fl.– 1.5 Dr. Practice, beautiful hospital, well equipped.

15% in GA: South Central GA: $818K+ gross, up 15% in 2017 gross under $1mm. (GA14F) 2017, 1.5just doctor practice.

Florida– Very profitable weeknight and weekend emergency clinic.

Nice hospital, well equipped hether PRACTICE OWNERS…now is the2017 time gross to sell!$1.16mm Whether Central Florida– an Solo Dr. Practice affluent area.

Nice, listing, or you’re pondering associate sale,inopen market listing, or free standing ~2800 sq. ft., 3 exam rooms.

2017 gross $580K. ractice corporate sale, Simmons will help! The current practice S.W. Florida– 2 to 2.5 Dr. well established Prx w/ ~3000 sq. rcial market is dynamic with buyers, and commercial ft.,sales 3 exam rooms, well equipped and well staffed.

Watson at financing available. Contact Dr. Doyle Watson at 2017 gross is ofreadily $1.8mm. nonSimmons Southeast today, for a complimentary, nonmative and obligatory consultation.

The dialogue will be informative and Are Corporate Groups contacting you about buying your Practice?

If so, let usAs help make sure you of getveterinary your best deal!!! ary practice time well spent. theyou original pioneer practice we have brokerage, we have been at this since 1977, so we have We are looking for quality practices to list in Florida. ommonlot.considering Let our knowledge, commonIfseen your a are selling yourexperience, Practice, calland us for a complimentary sense business judgmentConsultation!!! work for you.

mal, solo

GA 31522 nc.com m olina, er

Interested in selling your practice?

FREE Practice Appraisal MIAMI, FL– NEW LISTING! Grossing $1mil+, Owner willing to stay on PANHANDLE– COMING SOON! Grossing $1mil+, Ideal commercial location BRADENTON, FL– COMING SOON! Grossing $2.2 mil+, Associates in place PANHANDLE / 30A, FL- SOLD! Posh, Dream location, Grossing $750K

Practice Sales | Valuations Associate Buy-Ins

1610 Frederica Road, Saint Island, GA 31522 Contact Dr. Richard Alker for Simons further practice information.

Toll Free: (800) 333-1984 | www.simmonsinc.com 850.814.9962 or Richard@tpsgsales.com Email: southeast@simmonsinc.com Licensed in Properties Florida, Georgia, Carolina, Showcase of CentralNorth Florida, Broker and South Carolina Real Estate Broker

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Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809

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Sales & Acquisitions | Valuations | Exit Strategy | Facilitation | Buyers Agency

What’s your exit strategy?

Call Simmons to start your planning today.

(800) 333-1984 | Southeast@simmonsinc.com | www.simmonsinc.com | 1610 Frederica Road, St. Simons Island, GA 31522