Advocate 5, 2022

A DVO CAT E ISSUE 5 | 2021

AVIAN AND REPTILE CLINICAL PATHOLOGY

Peter Helmer, DVM, DABVP (Avian)- Page 12

FVMA LEGISLATIVE ADVOCACY

in partnership with Converge Government Affairs - Page 10

UPCOMING EVENTS 2022

mark your calendars - Page 15 & 23

LOOSE-CONTROL OF DIABETES MELLITUS IN CATS

Lisa Restine, DVM, DABVP (Feline) - Page 20

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

President's Message The year continues to be interesting and pass faster than I could ever imagine. The FVMA Annual Conference in June was a success–bringing together many to not only enrich their knowledge and skills, but also to reestablish personal contact.

This trend continued with the FAEP’s Promoting Excellence Symposium in October, FVMA Regionals in Panama City Beach in November and, a member favorite, The Gulf Atlantic Veterinary Conference in West Palm Beach early past December.

The FVMA office staff has been outstanding in their diligence and focus executing these educational opportunities for our equine and small animal practitioners.

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

As we embrace a new year, legislative activities in Tallahassee are in full swing with the reemergence of a bill that would allow a veterinarian-client-patient (VCP) relationship to be established by telehealth methods. A relationship where the prescribing veterinarian never meets the client or the patient, let alone does a proper examination. The FVMA is adamantly opposed to this as it undermines the core structure of veterinary training and the proper care we provide for our patients and our agricultural operation owners. Please join us in contacting your state representatives and senators and explaining to them we do not support telemedicine outside of a properly established VCPR. We absolutely do support telemedicine communication within a VCPR relationship that is current and appropriate.

In 2022, as we are full of hope and visions of a better future, I wish to express my truest hope that you are well and your family is well, and that we all learn to care a little more from all the trials the world has provided us to overcome.

Sincerely,

Dr. John R. Wight District 8–Northwest 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 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 Robert “Bo” Mayes Jackson, DVM Dr. Robert “Bo” Mayes Jackson, 68, died December 5, 2021.

Dr. Jackson received a Bachelor of Science degree from Auburn University, a Bachelor of Science degree from the University of Witwatersrand in Johannesburg, South Africa, and his DVM from the University of Georgia.

Born January 8, 1953, he was a lifelong resident of Lakeland, Florida. He was the owner of the Animal Medical Clinic.

He was a past president of the Lakeland Rotary Club and a Paul Harris Fellow, Leadership Lakeland Class IX and past

president of the Ridge Veterinary Society.

Dr. Jackson was a licensed general aviation pilot. He loved fishing and hunting in locations from Alaska to Africa. He was a member of the National Turkey Federation, Ducks Unlimited, Trout Unlimited and Coastal Conservation Association.

He was predeceased by his father, Dr. William Franklin Jackson. He is survived by his mother Barbara Mayes Jackson, sister Jane Jackson McEnerney (Joe), brother Mark Ainsworth Jackson, nieces Anne McEnerney Sand (Eric) and Nancy Mears McEnerney, and with his loving partner Nanette Jameson-Lee.

IN THIS ISSUE 3 4 5 6 10 12

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New Member Benefits In Remembrance FVMA Rebranding Member Spotlight Legislative Advocacy Update Avian and Reptile Clinical Pathology

FVMA Advocate

15 | FVMA Annual Conference 2022 20 | Loose-control of Diabetes Mellitus in Cats 23 | Upcoming Events 2022 24 | Practice Pulse 26 | FVMA 2022 Annual Budget 28 | Classified Ads

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 by 1986.

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

As we roll out digital media, please note FVMA Advocate will be reduced to four issues a year.

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. www.fvma.org

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Hester lecturing at UFCVM to the surgery club about surgery that can be performed in a general practice setting.

Images courtesy of Dr. Thomas Hester.

MEMBER SPOTLIGHT: Dr. Thomas Hester, MS, DVM FVMA Executive Board member and inaugural Power of 10 (P10) leadership program participant, Dr. Thomas Hester could never imagine being anything other than a veterinarian. Born and raised in Jacksonville, Florida, Hester aspired to be a veterinarian from a very young age. He obtained his bachelor's and master's degrees from the University of Florida and received his veterinary degree from the Ross University School of Veterinary Medicine. He completed his clinical year at the UF College of Veterinary Medicine (UFCVM).

Hester is passionate about the importance of organized veterinary medicine and has taken on numerous leadership roles. He has been active in the Alachua County VMA since graduating in 2012, served as president in 2014. He has also served on the executive board of the Florida Veterinary Medical Association representing District 2 since 2018. He became involved with the FVMA when the previous District 2 representative had to move out of state before her term was complete, and she approached Hester about taking over her seat. At the time, he says he did not realize how much the FVMA did for the veterinary profession, but after attending the first board meeting, he knew he had to get involved.

“There are so many issues facing our profession, from legislation to well-being and much more in between,” Hester says. “Unless we are out there fighting and making these decisions, someone else 6

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FVMA Advocate

will and that could have devastating consequences that are farther reaching than many may realize.”

On the note of challenges faced by veterinarians, Hester is intimately familiar with the financial struggle that so many young veterinarians now deal with.

“Outside of the challenges that everyone in our industry faces, younger veterinarians are faced with a significantly higher student debt load,” Hester says. “This is the most challenging thing for me, and I know that I am not alone. The future of our profession hinges on a solution to this problem, not only from a financial aspect but also well-being.”

He offers the following advice to anyone interested in the industry.

“First, explore all the options. People often think of going to veterinary school to become a small animal practitioner. A veterinary degree has endless potential though – large animal, equine, small animal, specialty, industry, teaching, research, public health, etc. Outside of becoming a veterinarian, there are also technician, assistant and practice management tracts. If you have an interest in veterinary medicine, there is likely an avenue for you to be happy and excel.

train the future leaders of veterinary medicine. P10 participants are trained on emotional well-being and awareness, leadership, business, legislation, communication and more. A new class is selected each year and it is envisioned that future leaders in organized veterinary medicine at the county, state, and national levels will come from the network of graduates of the Power of Ten. “Veterinarians are leaders,” Hester says. “Whether it be mentoring your staff, providing emotional support and education to your clients, teaching, or being a leader in your community. Veterinary school teaches you about medicine and surgery, but little about how to be an effective leader. We must instill these skills and knowledge in young veterinarians who will be protecting the profession for years to come. I feel that P10 will have a ripple effect not only in our profession but developing leaders throughout our communities as well.”

Hester believes in the importance of community, citing his clients’ trust in him to care for their four-legged family members as the highest honor he could receive. Although he knows the profession can be extremely stressful, he always feels that it is worth it. Hester has established many community ties since he began working at Trenton Animal Hospital in May of 2012.

Hester at work with Adeline, a rescue pet who he eventually adopted.

Image courtesy of Dr. Thomas Hester.

“Secondly, I would recommend speaking with a financial advisor as our cost of education can be daunting if you are not prepared.

As well as conducting research on the expectations of the human interaction and customer service that will be involved would also be beneficial. We not only deal with animals, but people too.”

In addition to his own experience as a relatively recent graduate, Hester is also a part of the Practice-based Small Animal Clerkship through UFCVM and has had a number of junior and senior veterinary students come through the clinic since the program started. His experiences mentoring young veterinarians are some of the most memorable of his career.

“Getting these students hands-on medicine and surgery experience and seeing them grow and become more confident over the few weeks that we spend together, really stands out in my mind,” Hester says. “I have also had many of them continue to reach out to me for mentorship as they finish school and move on to practicing themselves. It’s so rewarding being a part of the future of our profession.”

Hester himself is a young leader in the profession and is part of the inaugural Power of Ten (P10) class. P10 is the FVMA’s much anticipated leadership program designed to grow the leadership potential of young veterinarians from across Florida who have graduated in the past 10 years. A year-long series of workshops and meetings (split over fully sponsored weekends) is designed to

Hester after finishing the 5 Points of Life marathon in Gainesville, Florida. Right: friend and fellow veterinarian Dr. Erin Nadler. Left: Wife, Maya, and dog, Kona. Center: Hester.

Image courtesy of Dr. Thomas Hester.

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Then, attending to afternoon appointments and heading home to try and finish the day with an evening run. With patients that can’t tell you what’s wrong and never knowing what will walk in the door next, every day is a unique challenge. In his practice, he emphasizes the importance of educating clients and practicing medicine and surgery that is aimed at giving animals a healthy and happy life that is free of suffering. Hester also volunteers his services at the Gilchrist County Animal Shelter when needed and performs sterilization procedures at Trenton Animal Hospital twice monthly for a 501c group, which provides low-cost vouchers to pet owners in Gilchrist and surrounding counties.

When asked what he is most proud of at the end of the day, he says it depends.

“Some days it is related to work, others it is not. I’m very proud of the work that I do overall. I’m proud of my relationship with my wife and everything that she has achieved. I’m proud of my group of friends and family. Some days it’s a run that I just finished. I try and reflect and be proud of something every day while making sure to maintain a good work-life balance, which is very important.”

When speaking with people outside of the industry, he finds they are most surprised with the emotional toll that veterinarians bare.

Hester and Maya at the International Veterinary Emergency and Critical Care Symposium in Nashville, Tennessee.

Image courtesy of Dr. Thomas Hester.

“I am one of the rare people who found the perfect job for them on the first attempt,” Hester says of the clinic. “I started at Trenton Animal Hospital upon graduation and have been there since. We have a great group of doctors and support staff who are passionate about what they do, and I love them all. I also really enjoy practicing in a small-town, rural area, and the relationships that I have developed with the community are very valuable to me. I am treated as a part of the family by my clients and that feeling is mutual.

My technicians often have to pull me from an exam room because I spend so much time chatting with my clients about our lives!”

“We are a compassionate and empathetic group of people,” he says.

“Despite our best efforts, we are often not capable of leaving that at work at the end of the day.

As for the future, Hester plans to stay at Trenton Animal Hospital for the long haul and continue to be involved with organized veterinary medicine. Hester is married to his long-time love, Maya, and enjoys running, traveling, spending time with his pets, and taking care of his saltwater reef aquariums.

Professionally, Hester has a passion for surgery and has made it a goal to educate himself on advanced surgical procedures.

He points out that practicing in a rural area, where the nearest specialty hospital is over an hour away, it is extremely important for clients to have this option available. He is also one of the few veterinarians in his area to practice pot belly pig medicine. Hester’s other professional interests include pain management and geriatric care.

Hester’s typical workday begins with surgeries, followed by drop-off appointments, call backs and anything else that needs to be handled mid-day.

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FVMA Advocate

Hester and his wife, Maya, on vacation in Asheville, North Carolina.

Image courtesy of Dr. Thomas Hester.

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FVMA LEGISLATIVE ADVOCACY in partnership with Converge Government Affairs LEGISLATIVE SESSION 2022 update

January 11-21

The Senate and House convened for the 2022 Florida Legislative Session on January 11. Governor Ron DeSantis opened the 2022 session with a forceful defense of the way Florida has resisted rules aimed at reducing the spread of COVID saying that the tactic has worked - arguing "we were right, and they were wrong."

House Speaker Chris Sprowls challenged lawmakers to resist the urge to retreat to an easy comfort zone and to take a big picture view of problems facing the state and possible solutions.

The 2022 legislative session will end on March 11.

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Image courtesy of Shutterstock.

Senate President Wilton Simpson opened the new legislative session asserting lawmakers will spend more money on law enforcement and corrections officers and will prioritize education spending increases to include those besides teachers who make the school systems work, such as bus drivers and maintenance and cafeteria workers. Simpson, R-Trilby, also pushed for environmental stewardship, arguing that investing in environmental infrastructure assures the quality of life of Floridians and visitors associated with the state.

Bills we are monitoring for you:

SB 256 - Animal Cruelty

SB 448 / HB 723 - Veterinary Telehealth

SB 256: Referred to Judiciary; Agriculture; Rules

Sen. Brodeur

Sen. Brodeur, Rep. Buchanan

SB 448: Temporarily Postponed by Regulated Industries (1/3 committees) HB 723: On Committee agenda - Commerce Committee, 01/24/22, 3:30 pm, 212 K (2/2 committees)

The bill expands the grounds for a criminal penalty for depriving an animal of shelter or sustenance by removing the requirement that such shelter or sustenance be withheld unnecessarily. _______________________________________

• The bill allows the VCPR to be established via telehealth as long as the veterinarian is following the professional standards of care.

• The bill would not allow controlled substances to be prescribed via telehealth unless the veterinarian has already performed an in-person exam, with an exemption for hospice care.

• The Board has jurisdiction over veterinarians practicing telehealth in the state, regardless of where their offices are located.

• Allows animal control employees to administer rabies vaccines to impounded animals under the indirect supervision of a veterinarian. ________________________________________

SB 172 Courtroom Animal Advocates

HB 25 / SB 226 - Care for Retired Law Enforcement Dogs

HB 253: Referred to Regulatory Reform Subcommittee; Civil Justice & Property Rights Subcommittee; Commerce Committee

HB 25: Favorable with CS by Criminal Justice & Public Safety Subcommittee; 14 Yeas, 0 Nays (1/3 committees) SB 226: Now in Appropriations (3/3 committees)

The bill creates a noncriminal violation for selling a domestic dog or cat in a pet store. The bill creates an exception to the prohibition for individuals who breed and sell animals directly to the public. ________________________________________

Rep. Killebrew, Sen. Powell

The bill establishes a program to pay for the veterinary care of retired service dogs. ________________________________________

Sen. Pizzo and Sen. Book

SB 172: Referred to Judiciary; Agriculture; Rules HB 227: Withdrawn prior to introduction.

The bill would allow the court to appoint an advocate for an animal in a case regarding the welfare, care or custody of an animal. The advocate shall monitor the case, have access to relevant files, and present information and recommendations to the court. ________________________________________

HB 253 - Retail Sale of Domestic Dogs and Cats Rep. Killebrew

SB 416 / HB 833 - Animal Cremation Sen. Harrell, Rep. Silvers

HB 121 - Aggravated Animal Cruelty

SB 416: Now in Judiciary (2/3 committees) HB 833: Referred to Regulatory Reform Subcommittee; Civil Justice & Property Rights Subcommittee; Commerce Committee

HB 121: Referred to Criminal Justice & Public Safety Subcommittee; Justice Appropriations Subcommittee; Judiciary Committee

The bill requires a provider of animal cremation to provide a written description of their services and prohibits false or misleading descriptions of services. ________________________________________

Reps. Barnaby and Sirois

• The bill expands the crime of aggravated animal cruelty to include: » The unlawful killing of an animal in the custody of a family member. » Intentionally causing great bodily harm or death of an animal while in the commission of specified crimes. _______________________________________

SB 420 - Animal Abuse Sen. Pizzo, Sen. Book

SB 420: Referred to Judiciary; Criminal Justice; Rules The bill increases the penalties for animal abuse, sexual crimes involving animals, and fighting and baiting animals from misdemeanors to felonies. ________________________________________

- Continued on Page 18 www.fvma.org

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AVIAN AND REPTILE CLINICAL PATHOLOGY Peter Helmer, DVM, DABVP (Avian)

Image courtesy of Canva

Blood analysis is an important part of the health assessment of exotic pets. Physical exams may reveal less information than in other species, and bloodwork can find early signs of disease, or help to reinforce normal physical exam findings in the wellness setting.

Before blood can be analyzed, it must first be obtained. As a general rule, approximately 1% of body weight (or 1mL of blood per 100g of body weight) may be drawn in a single setting from a healthy animal. This means an average budgie, at 35g, could have 0.35 mL of blood drawn; a cockatiel at 100g could have 1 mL drawn, and a 500g Amazon could give 5 mL, if needed. Reptile blood draw amounts may be estimated in a similar manner.

Prior to drawing blood, ensure that sample requirements are known. Most automated cell counters are not compatible with avian and reptile blood as the RBC are nucleated. CBC are usually estimated from PCV tubes (for hematocrit measurement) and cover slip or microscope slide smears for white cell counts and differential assessment. Technique is very important, as excessive force can damage white cells, creating “smudge cells”, which will alter total and differential counts. Purple top, or EDTA-containing tubes, should be avoided as EDTA can cause lysis of cells in some species, resulting in artefacts. Chemistry panels may be run on serum or plasma. The use of heparin, usually in green top tubes with separator gel, allows for immediate centrifugation, without waiting for a clot to form. This results in fewer artefacts such as hypoglycemia and hyperkalemia when whole blood is allowed to sit unspun. Additionally, centrifugation of a heparinized sample without clot formation will generally result in a higher volume of usable plasma than if serum is obtained after clotting.

There are three main sites for phlebotomy in birds: the jugular, medial metatarsal and ulnar veins. The right jugular vein is larger than the left and is generally the site of choice for sampling. Most psittacines (and some other avian species such as poultry) have a featherless tract overlying the jugular vein that allows for easier visualization. The medial metatarsal vein courses up the medial aspect of the hock area and the ulnar vein is easily visualized on the ventral aspect of the elbow. Although these veins are slightly easier to visualize, they are significantly smaller and collapse easily, making it difficult to obtain sufficient volume for diagnostic samples.

In reptiles, phlebotomy can be a little more challenging. In lizards such as bearded dragons, iguanas and chameleons, the ventral coccygeal vein, or tail vein, is commonly used. This vessel lies on midline, just ventral to the vertebrae in the tail. Approaches from the ventral or lateral aspects of the tail are described, depending on personal preference. Of note is the network of lymphatics surrounding this vessel, which commonly results in lymph contamination of the blood sample. This will not affect chemistries, but will artefactually decrease cell counts and should be considered as one of the differentials for anemia and/or leukopenia.

Chelonians can pose a significant level of frustration when obtaining blood. Jugular veins are easily seen and sampled if the patient is particularly friendly; however, most turtles and tortoises withdraw their head into their shell and require sedation to access the jugular veins. The dorsal coccygeal vein, or tail vein, runs dorsal to the vertebral column on midline and may be accessible in otherwise uncooperative patients. Also accessible, particularly in aquatic turtles, is a venous sinus that lies just cranial to the cranial

aspect of the vertebral column. Even with head retracted (although be careful as turtles may bite) the round, cranial facet of the vertebra is palpated on midline, on the underside of the shell, dorsal and caudal to the head. Directing a needle to a spot just cranial to the facet will usually yield a good sample. Lymphatic dilution is also a common artefact at this location.

Needle and syringe selection is up to the phlebotomist. Small vessels collapse easily so, in general, small needles (25-28g) and syringes (0.3-1 mL) are used. Drawing blood rapidly (or expelling it rapidly into tubes) through small needles can result in hemolysis, so excessive pressure should be avoided. If the needle can be removed prior to expelling the sample into tubes, this is preferable.

Once the sample is obtained, blood smears (either slides or coverslips) should be made immediately and prior to contact with anti-coagulants. Microhematocrit tubes are filled for PCV measurement and the remainder of the sample is gently expelled into a micro-collection tube. If a green top (heparin) tube with separator gel is used, it should be centrifuged immediately.

The typical avian CBC has a PCV of 45-55%. The predominant white cell type is the heterophil (analogous to the mammalian neutrophil) with a lesser number of lymphocytes. Eosinophils, basophils and monocytes are generally only present in very low numbers. Notably, Amazon parrots, parrotlets and poultry may have a predominance of lymphocytes. Poultry also tend to have lower PCV. The classic inflammatory pattern is a mild anemia, moderate heterophilia and monocytosis. Toxic changes (such as degranulation of the heterophils) may be seen cytologically. Stress leukograms (heterophilia with leukopenia) are also seen in avian patients, particularly macaws, and must be differentiated from true inflammation.

Reptiles tend to have a lower hematocrit (30-40%). Heterophils again predominate. An additional leukocyte is present in the differential: the azurophil. These cells are generally grouped in with the monocytes and reptilian inflammatory leukons usually consist of heterophilia and azurophilia, although azurophilia alone is commonly encountered with low grade, chronic inflammatory disease.

Although many analytes are included in avian chemistry screens, the most useful on a routine basis are AST, CPK, uric acid, calcium and bile acids. Unlike dogs and cats, where fasting and post-prandial samples are needed, a single point measurement of bile acids is sufficient. BUN and creatinine are not useful in the diagnosis of renal disease in birds. Mild uric acid elevations may be a result of dehydration, whereas more moderate or marked increases should raise concern for renal dysfunction. AST and CPK are evaluated in tandem, as AST elevations may indicate muscle or hepatocyte damage. CPK elevations are generally a result of muscle damage; thus, if both are elevated, trauma or other muscular insult should be considered, whereas an elevation of AST alone may point more towards hepatic insult. Bile acids evaluation can also help with this distinction and will rise with decreased hepatic function. Bile acids should be included in every avian chemistry screen if at all possible. Calcium measurement (both total and ionized if possible) is particularly useful in diagnosis and management of reproductive disease. The most common cause of hypercalcemia is reproductive

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activity in the female. Parathyroid and paraneoplastic causes of hypercalcemia are far less common.

FROM BEGINNING TO END, YOU WERE HERE FOR THEM

The reptile chemistry panel has many similarities to the avian panel; however, some important differences exist. The role of bile acid measurement is not as well understood. AST and CPK are still interpreted in tandem. Uric acid evaluates renal function, although BUN may be useful in some reptiles, especially the aquatic turtles. The high prevalence of metabolic bone diseases demands particular attention be paid to calcium and phosphorus values. Not only should the absolute values be noted, but the ratio of calcium:phosphorus should be at least 1.5:1. Lower, or inverse ratios (i.e. when the phosphorus is greater than the calcium) may be indicators of renal disease, inadequate calcium intake, hypovitaminosis D or other pathology. Hypercalcemia is common with reproductive activity in the female reptile.

In summary, hematological testing is commonly indicated in avian and reptile patients. Samples may be readily and safely obtained, and with a little preparation, important diagnostic information may be gleaned. Contact your diagnostic lab to determine the most appropriate samples for submission to maximize diagnostic yield.

Additional Resources:

"Advances in Clinical Pathology and Diagnostic Medicine" in Speer BL, Editor, Current Therapy in Avian Medicine and Surgery. Elsevier, 2016 "Clinical Pathology of Reptiles" in Mader DR, editor, Reptile Medicine and Surgery, Saunders, 2006.

"Clinical Pathology and Sample Collection" in Reavill DR, editor, The Veterinary Clinics of North America, Exotic Animal Practice. 2(3) Sept 1999, Saunders, 1999.

Fudge, AM Laboratory Medicine: Avian and Exotic Pets.

Saunders, 2000.

PETER HELMER

DVM, DABVP (Avian)

Dr. Peter Helmer is a graduate of the Ontario Veterinary College.

After two years in private avian/ exotic pet practice in Calgary, Alberta, he traded snowballs for sandcastles and headed south to Florida, with a brief stop at Kansas State University to complete an internship in Zoo and Exotic Animal Medicine. Peter is currently the senior clinician with the Avian and Exotic Pet Medicine Service at BluePearl Veterinary Partners in Clearwater, Florida.

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.

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WET LAB SCHEDULE

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Basic Small Animal Abdominal Ultrasound

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Adv. Small Animal Abdominal Ultrasound

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Dentistry Wet Lab 8:00 a.m. – 12:00 p.m. Laser Therapy: Practical Information for Successful Implementation and Optimum Results.

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Veterinary Point-of-Care Ultrasound

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SUNDAY, MARCH 20 6:00 a.m. – 7:00 a.m.

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6:30 a.m. – 11:30 a.m.

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8:00 a.m. – 12:00 p.m. Laser Therapy:Why Conventional Thinking About Laser

Christian Fellowship Breakfast Coffee Break/Breakfast Pastries Registration Open Florida Laws & Rules Continuing Education Sessions

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Therapy is Wrong-What That Means to Your Practice.

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LECTURE TOPICS • • • • • •

ANESTHESIA AND PAIN MANAGEMENT AVIAN AND EXOTICS BEHAVIOR MEDICINE CARDIOLOGY CLINICAL PATHOLOGY DENTISTRY

• • • • •

DERMATOLOGY EMERGENCY MEDICINE AND CRITICAL CARE FELINE/RENAL MEDICINE IMMUNE-MEDIATED DISEASES INFECTIOUS DISEASES

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INTERNAL MEDICINE MEDICINE FOR TECHNICIANS NEUROLOGY OPHTHALMOLOGY ORTHOPEDICS AND PHYSICAL THERAPY

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- Continued from Page 11 HB 435 - Animal Abuse Rep. Grieco

HB 435: Now in Justice Appropriations Subcommittee (2/3 committees) The bill establishes a third-degree felony for allowing a minor to attend the fighting or baiting of animals. The bill also changes the definition of sexual contact with an animal to be more detailed and broad. ________________________________________

SB 614 / HB 721 - Authorization of Restrictions Concerning Dangerous Dogs Sen. Garcia, Rep. Buchanan

SB 614: On Committee agenda - Community Affairs, 01/25/22, 3:30 pm, 37 S (1/3 committees) HB 721: Now in Regulatory Reform Subcommittee (2/3 committees) The bill would allow a Housing Authority created under the Public Housing law to adopt an ordinance to restrict the ownership of domestic animals who have attacked or bitten persons. ________________________________________

SB 994 / HB 849 - Pet Protection Sen. Diaz, Rep. Fernandez-Barquin

SB 994: Now in Community Affairs (2/3 committees) HB 849: Referred to Regulatory Reform Subcommittee; State Administration & Technology Appropriations Subcommittee; Commerce Committee The bill requires pet stores to obtain a newly created license from the DBPR to operate as retail pet stores. Retail pet stores would not be allowed to offer for sale or give away any household pet unless it was acquired from one of the following: - A qualified breeder - A breeder exempt from licensure by the U.S. Dept. of Agriculture - An animal rescue - An animal shelter - A pet broker The retail pet store cannot sell or give away a pet younger than eight weeks, one who has not been implanted with a microchip or who does not have a valid veterinary certification. ________________________________________

HB 1061 / SB 1750 - Sale of Dogs and Cats Rep. Killebrew, Sen. Wright

HB 1061: Referred to Regulatory Reform Subcommittee; Civil Justice & Property Rights Subcommittee; Commerce Committee SB 1750: Referred to Regulated Industries; Commerce and Tourism; Rules

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FVMA Advocate

The bill states that consumers who finance the purchase of a pet are entitled to terminate the financial arrangement with no penalty to the consumer if the pet is found to have been unfit for sale by a veterinarian. ________________________________________

HB 1075 / SB 1508 - Tethering of Domestic Dogs and Cats Rep. Slosberg-King, Sen. Taddeo

HB 1705: Referred to Civil Justice & Property Rights Subcommittee; Judiciary Committee SB 1508: Referred to Community Affairs; Agriculture; Rules The bill makes it illegal to tether an unattended domestic cat or dog. ________________________________________

HB 1279 / SB 1718 - Cosmetic Animal Testing Rep. Arrington, Sen. Book

HB 1279: Referred to Regulatory Reform Subcommittee; Professions & Public Health Subcommittee; Commerce Committee SB 1718: On Committee agenda - Commerce and Tourism, 01/24/22, 3:00 pm, 110 S (1/3 committees) The bill bans cosmetic testing on animals, with certain exceptions. ________________________________________

HB 1341 / SB 1806 - Animal Abusers Rep. Arrington, Sen. Jones

HB 1341: Referred to Criminal Justice & Public Safety Subcommittee; Justice Appropriations Subcommittee; Judiciary Committee SB 1806: Referred to Judiciary; Appropriations Subcommittee on Criminal and Civil Justice; Appropriations The bill creates a statewide Animal Abuser Registry. This bill will place restrictions on a convicted animal abuser to own, adopt, live with or work with animals. ________________________________________

SB 1548 - Occupational Licensing Sen. Perry

SB 1548: Referred to Regulated Industries; Criminal Justice; Rules The bill would prohibit a board from inquiring into the criminal history of an applicant until after the board determines whether the applicant is qualified for a license. The conviction of a crime may not be the grounds for the denial of a license. ________________________________________

SB 1838 / HB 1463 - Student Financial Aid Sen. Taddeo, Rep. Driskell

SB 1838: Referred to Education; Appropriations Subcommittee on Education; Appropriations HB 1463: Referred to Post-Secondary Education & Lifelong Learning Subcommittee; Higher Education Appropriations Subcommittee; Education & Employment Committee The bill states that for purposes of receiving state financial aid awards, a student may not be denied classification as a resident based on his or her immigration status. The bill establishes the Professional Student Loan Repayment Program within the Department of Education, which would be open to veterinarians. ________________________________________

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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.

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LOOSE-CONTROL OF DIABETES MELLITUS IN CATS Lisa Restine, DVM, DABVP (Feline)

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Image courtesy of Shutterstock

FVMA Advocate

Following hyperthyroidism, diabetes mellitus (DM) is the second most common endocrine disease of domestic cats. It is characterized by an elevation in blood glucose levels, and cats often experience one or more clinical signs including weight loss, polyuria (PU) and polydipsia (PD), as well as polyphagia. There are multiple ways to manage DM in cats, and this article will discuss loose-control, which focuses on primarily controlling the clinical signs of the patient over keeping blood sugar levels in an “optimal” range.

DM in cats is often a frustrating disease for practitioners to manage. In-hospital glucose curves are often difficult to interpret due to stress and other factors. Many clients will check spot glucose levels at home and request consistent input from the veterinarian regarding what to do with the numbers they are seeing on their glucometer. This can be time consuming for the veterinarian and difficult to do appropriately without seeing the cat on a regular basis. The cat may have “normal” glucose values but will still be experiencing significant clinical signs of DM, which can cause an owner-perceived poor quality of life for the patient. In some

cases, this may result in euthanasia.1 Owners may also decline to test at home or become noncompliant over time resulting in poor diabetic regulation.1 The frustration for practitioners managing DM regarding the disagreement between the cat’s blood glucose levels and its clinical signs adds to the overall difficulty of managing the disease.1 In one study, control of DM using clinical signs was “markedly better” than what the blood glucose or fructosamine levels indicated.2 Owners often disagree with practitioners about the degree of control in the diabetic cat based on the cat’s clinical signs versus the blood values obtained by the veterinarian.3 There are two ways to interpret diabetic control in cats: 1) achievement of remission and 2) resolution of clinical signs and good quality of life. Remission is not consistently defined in the literature but will be defined here as the patient being euglycemic without exogenous insulin supplementation for a period of at least 30 days.

Table 1. Recommendations for insulin dose changes based on clinical signs and a single blood glucose determination at approximately 12 hours post-insulin for cats receiving protamine zinc insulin (PZI) *1 Stop insulin for 2 to 4 d then recheck the BG. ≤ 180 mg/dL (9.9 mmol/L)

• If BG is normal, discontinue insulin until clinical signs return.

• If BG is elevated and clinical signs have returned, resume insulin at about 50% of the previous dose and recheck in 1 week.

180-250 mg/dL (9.9-13.8 mmol/L)

Although the clinical signs will be well- controlled, decrease the dose by about 50% and recheck in 1 week for potential further dosage adjustment.

250-300 mg/dL (13.8-22.1 mmol/L)

Clinical signs will be well-controlled. Decrease the dose by about 50% and recheck in 1 to 2 weeks for potential further dosage adjustment.

300-400 mg/dL (16.6-22.1 mmol/L)

If clinical signs are controlled, continue present dose and recheck in 4 wk. If not, maintain current insulin to determine the presence of stress hyperglycemia. If fructosamine is not determined or is normal, continue present dose and recheck in 4 weeks.

If clinical signs are not well-controlled, increase dose by about 33% and recheck in 1 to 2 weeks.

400-500 mg/dL (22.1-27.6 mmol/L)

Be cautious with these cases. If the dose is increased by more than 33%, recheck in 1 week.

Beware of occurrence of hypoglycemia.

Consider rechecking blood at 6h post-insulin or a serum fructosamine.

If the cat is lethargic or has a poor appetite, check blood pH and test for ketones in the urine or serum.

Evaluate the cat’s clinical signs and blood for DKA and check for ketones in the urine or serum.

500-600 mg/dL (27.6-33.1 mmol/L)

If negative continue the recommendations for the not well-controlled 400 to 500 mg/dL group.

Consider treatment for concurrent disease (e.g., dental disease, urinary tract infection, pancreatitis).

*This table is a guideline and does not cover every individual scenario for each patient. Use with discretion.

In addition to insulin therapy, the patient should be placed on a low carbohydrate, high protein diet. There are several therapeutic and over-the counter options available in case the cat is a finicky eater. In the beginning, the diet should be offered free choice, but as regulation of DM occurs, food restriction in obese cats can encourage healthy weight loss and improve diabetic control. When done appropriately, loose-control of DM in cats is a great way to manage diabetes. It improves the cat's clinical signs which results in an increase in quality of life for cat, owner and veterinarian.

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When using the loose control method, protamine zinc insulin (PZI) is preferred. Its nadir occurs between 5-7 hours and it lasts 10-14 hours and is considered a long-acting insulin. This differs from Vetsulin which has a more unpredictable nadir (1.5-8 hours) and lasts 8-12 hours and glargine/detemir which have nadirs of 10-14 hours and durations of action of 12-24 hours. Vetsulin is not as ideal an insulin in cats due to its inconsistent nadir and shorter duration of action. Glargine and detemir require more intensive management due to the duration of action and should not be considered for the loose control approach. PZI should be given subcutaneously every 12 hours.

Since the primary concern for the loose control approach is resolution of clinical signs, there a large emphasis placed on a thorough medical history at the time of blood glucose determination. Since the nadir of PZI can vary between 5-7 hours, a 12-hour glucose check is done to determine blood sugar level. This check is ideally done in the clinic setting. The owner is questioned about the cat’s eating habits (increased/decreased) drinking and urination (looking for changes in PU/PD), and overall activity level and perceived quality of life at home.

Since some owners may not be as observant as desired or may have more than one cat, a complete and accurate history can sometimes be difficult to obtain. A weight and complete physical examination will provide unbiased data as to how the cat is doing overall. A well-regulated diabetic will often gain weight or if stable, maintain their weight. Diabetic cats can often have greasy or unkempt haircoats which can improve with DM regulation.

In some cases, cats experience diabetic neuropathy, a hindlimb weakness associated with a plantigrade stance can occur. This is due to demyelination of the axons due to hyperglycemia. As the hyperglycemic levels improve, so will the symptoms of diabetic neuropathy.

The practitioner should weigh all the information provided from the owner as well as what was obtained at the clinic and then use that plus the spot glucose done at 12 hours post insulin to determine any needed dose adjustments. For dosing suggestions, see Table 1. It is important to note that clinical signs and weight are more important than the blood glucose value obtained.

It is also important to realize that cats can experience stress hyperglycemia, and it is possible that the blood sugar value obtained may be 50-100 mg/dL higher than what it would be if the cat was not stressed. This can account for some discordance in the clinical signs and blood glucose values.

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FVMA Advocate

References: 1. Norsworthy GD, Wexler-Mitchell E. Management of diabetic cats in primary care practices: ABVP roundtable report. J Feline Med Surg 2015; 17:967–969.

2. Restine LM, Norsworthy GD, Kass PH. Loose-control of diabetes mellitus with protamine zinc insulin in cats: 185 cases (2005–2015). Can Vet 2019; 60:399-404 3. Hoelmkjaer KM, Spodsberg EMH, Bjornvad CR. Insulin detemir treatment in diabetic cats in a practice setting. J Feline Med Surg 2015; 17:144–151.

LISA RESTINE

DVM, DABVP (Feline)

Lisa Restine is a 2014 graduate of Western University of Health Sciences: College of Veterinary Medicine. She has been practicing at Alamo Feline Health Center since graduation. This practice features a wide variety of both medical and surgical cases on both a general practice and referral level. Lisa achieved board certification with the American Board of Veterinary Practitioners in feline medicine in 2020. She is a virtual consultant to international practitioners in Hong Kong, Singapore and Malaysia. Dr. Restine lectured on feline diseases in multiple locations throughout China on an Abaxissponsored speaking tour in 2018. She is co-editor of The Feline Patient, 5th ed., which was published in April 2018.

Dr. Restine enjoys a broad spectrum of expertise in feline medicine and surgery. She has a special interest and training in feline dentistry and internal medicine. She is passionate about feline medicine and sharing her love of practice and knowledge in order to help improve feline care.

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PRACTICE Pulse QUESTION: I know we can charge a fee for written prescriptions but one of my associate vets recently attended the FVMA conference, where it was mentioned that it is not legal to charge the fee at the time of a physical exam. I was hoping to see if this is correct, and get a bit of clarification.

A:

You can be disciplined for “failing to give the owner of a patient, before dispensing any drug, a written prescription when requested” (see Section 474.214(1) (pp), F.S.). In other words, if you are willing to dispense the medication at that point, you are required to write a prescription and not charge for it. If the client stops by at a future date without the animal and requests a prescription, you can charge the reasonable costs of pulling up the records and ascertaining that the required testing is up to date. That reasonable cost should not be more than $10-15.

As a marketing/goodwill policy, you should consider whether charging for this is a good idea.

QUESTION: At our practice, we hired a recent graduate. He

below, which states it requires “immediate supervision.” On top of that, Telazol is a Schedule III controlled substance so handing out a couple of bottles to a veterinary technician creates regulatory issues for the veterinarian, such as maintaining an accurate controlled substance log.

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 Section 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.

passed his NAVLE and state boards and has graduated. His college is behind on releasing his transcripts, but he wants to work now. Is this allowed under the state law? I found confusing wording in the law when I investigated.

(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 Section 474.202(5), F.S.

A: If he has done everything he needed to do and is waiting for

(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 Section 474.202(5), F.S.

his license, he can work under supervision of another veterinarian.

QUESTION: Am I allowed to save on doing pharmacy

prescription labels by keeping those for OTC products like shampoos, treats, cookies and training stuff ? Or am I obligated to put a label on everything that comes out of our building whether it’s OTC or prescription?

A:

We are unaware of any requirement to put a label on an OTC (nonprescription) item. Such a label is sometimes done for marketing purposes.

QUESTION: I have a question about a legality for a rescue

group. This group currently has 250 cats, and they have just moved into a new facility. They tested almost all their cats since some of them were touring out FELV +. You can imagine what a feat that has been, and we have been having them bring in the feral cats for sedation to test them. Would it be legal for me to give them a bottle or two of Telazol for their volunteer CVT to do their own testing within their facility? It has become very difficult for me to fit them into my schedule as I’ve become very busy as a result of the pandemic.

A:

Unfortunately, we see an issue with the administration of tranquilization by a veterinary technician. See Paragraph (2)

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FVMA Advocate

QUESTION: I have a question concerning prescription refills

and the VCPR. I see from the state rules for veterinarians that medication refills require an active (current) veterinarian client/ patient relationship, but I am having a hard time finding in the statutes an actual timeline (ie: how long after last seeing the patient can medication refills be granted). I thought it was no more than a year after last seeing the patient, but I cannot find this specifically written in Florida statutes.

A:

The reference you seek can be found in Rules Chapter 61G18-30 DISCIPLINE. 61G18-30.001 Disciplinary Guidelines (2) (y) 3.

Maintain records which document patient visits, diagnosis, treatment, and other relevant information required under this chapter. The documented patient/client/veterinarian relationship cited in Section 474.214, F.S. is herein defined as a veterinarian’s record pf a client’s animal which documents that the veterinarian has seen the animal in a professional capacity within a period of 12 months or less.

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.

QUESTION: I dropped an entire bottle of Midazolam on the

floor and it broke. Am I required to do anything other than to enter into my logbooks that it was dropped and discarded?

A: https://www.deadiversion.usdoj.gov/21cfr_reports/surrend/ The above link takes you to the instructions and the DEA Form 41.

The form is used to document the accidental loss of a controlled substance. The form is NOT SENT TO DEA; instead it must be kept, completed with your records, so that in case of an audit, you have a record of what happened.

QUESTION: I am involved in a veterans organization that

has a building where members congregate. There has been a lot of discussion lately regarding service dogs and which ones are allowed to be in the building (as we serve food/drinks); and what we are allowed to ask for legally, as well as what the legal definitions are of service animals?

A:

The Florida law pertaining to this is F.S. 413.08 Rights and responsibilities of an individual with a disability; use of a service animal; prohibited discrimination in public employment, public accommodations, and housing accommodations; penalties.

The two important things related to your question are reproduced below. a) “Emotional support animals” are not service animals and can be excluded. b) You can’t ask for documentation of training, or what the person’s disability is. You can ask if the animal is a service animal and what work or tasks the animal has been trained to perform.

“Service animal” means an animal that is trained to do work or perform tasks for an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. The work done or tasks performed must be directly related to the individual’s disability and may include, but are not limited to, guiding an individual who is visually impaired or blind, alerting an individual who is deaf or hard of hearing, pulling a wheelchair, assisting with mobility or balance, alerting and protecting an individual who is having a seizure, retrieving objects, alerting an individual to the presence of allergens, providing physical support and assistance with balance and stability to an individual with a mobility disability, helping an individual with a psychiatric or neurological disability by preventing or interrupting impulsive or destructive behaviors, reminding an individual with mental illness to take prescribed medications, calming an individual with posttraumatic stress disorder during an anxiety attack, or doing other specific work or performing other special tasks. A service animal is not a pet. For purposes of subsections (2), (3), and (4), the term “service animal” is limited to a dog or miniature horse. The crime-deterrent effect of an animal’s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for purposes of this definition.

Documentation that the service animal is trained is not a precondition for providing service to an individual accompanied by a service animal. A public accommodation may not ask about the nature or extent of an individual’s disability. To determine the difference between a service animal and a pet, a public accommodation may ask if an animal is a service animal required because of a disability and what work or tasks the animal has been trained to perform.

QUESTION: I have searched everywhere and cannot find the

answer to this. The last hospital I worked for said it was against the law to split tablets because it is considered compounding as we are altering the drug from its original form. The hospital I currently work for splits tablets for every client requiring a half or quarter of a drug. Can you please clarify so I can determine if we need to.

A: There are two things at issue here.

Is splitting a tablet compounding? The FDA has not formally clarified this issue (splitting tablets). Compounding involves changes to a finished dose, and splitting tablets alters the finished dose in a way that simply transferring medication to a different package or container does not. So, is it compounding in a very hyper-technical sense? Perhaps. However, it is not compounding as defined by Florida law. “Compounding” means combining, mixing or altering the ingredients of one or more drugs or products to create another drug or product.”

The splitting of the tablet does not involve mixing or altering ingredients to create another product. So, there is ABSOLUTELY no issue whatsoever with splitting tablets to meet the needs of a specific patient.

The second related issue is: can a veterinarian compound a drug for the need of a specific patient? The answer is YES. For example, let’s say you need to use a particular FDA-approved medication for an ear infection in a dog, but the medication only comes in an injectable form. Following the FDA’s rules, you could mix the FDA-approved product with normal saline for instilling into the ear. This would create another product. Veterinarians are authorized to compound for their own patients.

www.fvma.org

END NOTE: The ultimate responsibility

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

@thefvma

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FVMA 2022 ANNUAL OPERATING BUDGET APPROVED The FVMA Executive Board approved the Association's 2022 operating budget in November 2021, with a balanced budget of more than $3 million.

This budget reflects the FVMA’s continued growth, as well as its commitment to the sustainability of the Association’s current programs and services, to advancing strategic goals and to broadening the delivery of high-quality services to the diverse veterinary professional community of our state. We are equally committed to exercising sound stewardship of FVMA membership fiscal resources.

The strength of the FVMA has enabled us to expand our continuing education services and grassroots advocacy efforts, allowing the association to become the premiere voice of veterinary medicine in Florida. I encourage you to join the FVMA Professional Advocacy Committee or make a financial contribution. We ask that members become more engaged at the local level in order to support your Association’s legislative and regulatory initiatives in 2022.

We recognize the invaluable contributions all members of the veterinary team make to animal health and well-being, along with the advancement of our profession in Florida, and we invite these professionals to join our ranks to strengthen the voice of veterinary medicine in our state.

The FVMA has the fiscal resources, experienced leadership and the dedicated professional staff to expand and enhance our membership services and outreach. It's an all-encompassing effort to continue to serve our membership well, protecting and advancing the veterinary profession in Florida. The 2022 budget equips the FVMA to perform efficiently in all areas of operation and carry out all of its important functions.

Let us be inspired by the FVMA’s mission statement: to advance the veterinary medical profession, promote animal health and well-being, and protect public health.

If you have any questions regarding the 2022 fiscal operating budget, please direct them to me or Interim Executive Director Jim Naugle.

Thank you for the opportunity to serve this great profession.

Respectfully,

Donald H. Morgan, DVM Treasurer

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FVMA 2022 FISCAL OPERATING BUDGET INCOME

Membership Dues $ 1,092,117 FVMA Political Committee $ 16,000 Continuing Education/Certification Programs $ 1,845,412 Publications $ 55,333 FVMA Foundation Member Services Income $ 115,060

TOTAL INCOME

$ 3,123,922

EXPENSES Facility Costs & Upkeep $ 205,026 Membership Services & Administration $ 1,326,398 Legislative Advocacy $ 104,000 Educational Program Expenses $ 1,291,181 Communications & Public Relations $ 63,920 Inter-professional Relations $ 19,850

TOTAL EXPENSES

$ 3,010,375

NET INCOME OR (LOSS): $113,547

www.fvma.org

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CLASSIFIED ADVERTISEMENTS 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. (5/21 / #592) VETERINARIAN TECHNICIAN WANTED – ORLANDO, FL: Seeking an enthusiastic and energetic Veterinary Technician to assist our four Veterinarians with daily appointments as well as provide excellent care to our patients. As a healthcare team, we provide consistent quality medicine, compassionate care and a fear free low-stress environment.

Our hospital has been thoughtfully designed to maximize the workflow for technicians while also providing a low-stress and inviting environment for our patients. Full-time position with benefits package. Check out our hospital at lochhavenvet.com. For more information please contact Lizz Capo at (407) 896-0941 or by email at lizzcapo@lochhavenvet.com.

(Issue 5, 21 / #14790) VETERINARIAN TECHNICIAN WANTED – CENTRAL FLORIDA / TOP PAY: Looking for experienced veterinary technicians in the Central Florida Area with top pay. Please contact Dr. Larry Adkins at (407) 529-5651. (Issue 5, 21 / #28095)

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 5, 21 / #26934) ACCESS – PALM BEACH COUNTY: Advertising | Recruiting | Doctors – Urgent Care Ref: APBC-Advert-Recruiting-Doctors-Urgent-Care-v2 DRAFT ONLY Wanted: Calm, cool, and collected Urgent Care doctors.

We’re a large multi-specialty animal hospital with an ER department where patients with non-life threating symptoms are having to wait for ER doctors who are busy with a steady flow of life-threatening cases.

Naturally, we’d like to see all patients in a timely manner, but the 5999 To meet this demand, we are launching an Urgent Care (UC) department, with dedicated UC doctors to care for patients with non-emergent conditions such as hot spots, ear infections, lameness, gastrointestinal disturbances, and urinary tract infections, etc.

The sweet spot in veterinary medicine.

If the above makes sense to you and the below sounds like something you’ve been searching for, we’d love to hear from you.

• You’re looking for a role that slots in smoothly between a highpaced ER position and the calmer pace of general practice.

• You value working within a modern, multi-specialty hospital environment.

• You’d prefer a workday that enables you to spend time on a beach in the early morning and to be home in time for dinner.

• You’ve had internship training and/or experience in either GP or ER hospitals.

• You are dedicated to providing quality outpatient medicine

VETERINARY REGIONAL SALES DIRECTOR WANTED – FLORIDA: Our dynamic newly formed Veterinary company is searching for a experienced veterinarian Regional Sales Director for an “Exclusive” territory within the the state of Florida.

• You are empathetic and want clients to be taken care of in a professional manner

This could also include a Florida based Veterinarian distributor.

• You’d prefer to work in an environment where collaboration with specialty doctors and staff is encouraged. (Your input, ideas, and suggestions matter.)

This Regional Sales Director will have the current qualifications to be considered: • This is a commission type position (No salary or expenses provided) • All applicants must currently be calling on Veterinarians • Has a track record of sales success • Has several years of Veterinarian sales experience • If currently an Independent Sales representative, you have time for an additional surgical product We are a well established Medical/Veterinarian small business SDVOSB based in Florida Our product offering has already been sold and we have several very strong testimonials on the efficacy and need for our product!

We also have a very exciting therapy product coming out early next year!

Veterinary Tech experience is a plus!

All necessary training and support will be provided All qualified applicants will be able to learn more about our company, review our website and see in person this needed product!

We look forward to a new valuable team member joining us on this journey! For more information please contact Ron Flora at flora17302@aol.com. (Issue 5, 21 / #50472)

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• You appreciate the value of close contact with primary care veterinarians, their patients, and their clients.

• Act urgently!

• To find out more about your Urgent Care role, our hospital, and the people with whom you’ll be working, please contact Ken Spokane.

You’ll find him approachable, relaxed, and ready to answer your questions.

Ken Spokane, MBA, BSA; Hospital Administrator;ACCESS – Palm Beach County; Email: kspokane@accessvet.com Tel: (561) 774-8760 (Issue 5, 21 / #51999) VETERINARIAN PRACTICE FOR SALE – FLORIDA: Retiring veterinarian is selling profitable veterinary practice. Leased facility is located between Miami and Fort Lauderdale, one of the fastest growing areas in Florida. Minutes from nice schools , sunny beaches. High visible from the busy road, near major highways. 2 exam rooms, 1 surgical room, lab area, treatment room. Practice has been in current location for over 30 years with loyal clientele. Practice opens 4.5 days a week.

No after hour emergencies. 2020 gross revenue was 633K, cash flow 280K. High growth in 2021. Low overhead. Great potential. Call today for details. southfloridavet85@gmail.com or (305) 684-3265.

Or visit Website: http://southfloridaveterinarypracticeforsale.com (Issue 5/2021 #49454)

Interested in placing a Classified Ad? FVMA classified ads provide opportunities for employers, salespeople, prospective employees and buyers to connect, with possible placement in our print publication, and on our website. If you would like to place an FVMA classified ad, please complete the form by scanning the QR code or visiting the website at https://fvma.org/tools-resources/fvma-classified-ads/, including submitting your ad language exactly as you would like it to be published at the end.

SCAN QR CODE TO LEARN MORE

Classified ad rates:

Discoun ts

ava publishilable when you i - 800 n multiple issues

.992.38

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FVMA Member: • Print (per issue) – $55 minimum, up to 50 words; $0.25/word over 50 • Addition of photo/logo – $25 • Online (90 days) – Free Non-FVMA Member: • Print (per issue) – $95 minimum, up to 50 words; $0.25/word over 50 • Online (90 days) – $95 minimum, up to 50 words; $0.25/word over 50 • Bundle (Print and Online) – $150, up to 50 words; $0.25/word over 50 • Addition of photo/logo – $40

Best Friends Forever

International Health Certificate Solutions forms, Worldwide • Nationwide e h t o d e W the exam airanimal.com ou do

Y

Photo credit: www.123rf.com/profile_sam74100

www.fvma.org

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S.E. Florida- 1 Dr.,lease space, 2020 gross $675K, growth area motivated seller, well equipped, good growth in 2021.

Coastal Panhandle- Solo Dr. grossing $1.1M, 2200 sq. ft., 2 exam rooms, tenured staff, after debt income ~$190K. SE Florida-Mobile Equine Practice- Solo Dr. grossing $745K. All the bells and whistles you need with a substantial after debt income. Owner financing!

New-West Coast north of Tampa- Solid solo Dr. Practice grossed almost $1.2mm in 2020. lease space w/3 exam rooms, well equipped, experienced staff, very profitable.

New-North-Central Fl.-Solo Dr. 2020 gross $1.4M still growing, everything you need make a great living.

New-West-Central Fl.-Solo Dr., lease space 2020 gross $880K, after debt income of $200K. owner willing to stay for up to 2 yrs.

New-Central Florida- Solo Dr. 2020 gross $920K, free standing office, 2 exam rooms, well equipped after debt income ~$210K. New-Central Fl.-Equine Prx, 2 Dr. Hospital, barn, gross $690K

YOUR AD GOES HERE. Email - communications@fvma.org Call 800.992.3862 for more details or scan QR code.

When Selling or Buying a Veterinary Practice...

Call on

Practice Sales Buyer Representation Associate Buy-Ins Exit Strategies Appraisals Richard Alker, DVM Florida Representative

850.814.9962

e-mail: Richard@TPSGSales.com www.TotalPracticeSolutionsGroup.com

The only Veterinary Practice Broker 30

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FVMA Advocate

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Veterinary Practice Sales, Acquisitions & Valuations

BROWARD COUNTY: Small animal practice with $1.3M gross revenue! 3,000 SF leasehold with 4 exam rooms.

(FL100) MIAMI-DADE COUNTY: Small animal practice in prime location! 2,850 SF leasehold + mobile. Option to buy real estate. (FL105) PALM BEACH COUNTY: Small animal practice in prime location with boat dock!

2,976 SF facility with real estate.

(FL107) PALM BEACH COUNTY: Primarily house call, small animal practice! Annual growth rate over 18%. 1,600 SF leasehold.

(FL109) TAMPA BAY AREA: Small animal practice with gross revenue over $1.59M! 1,942 SF facility. Real estate is included.

(FL111) WEST CENTRAL COAST: Small animal practice with gross revenue over $750K! 2,200 SF leasehold. Busy shopping center!

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Practices for Sale NEW LISTING! FL, Northwest Coast: 10 miles to Hernando Beach. 100% SA, solo DVM, $700K gross. 3,634SF facility on .48 acres w/ 3 exam rooms, on a major highway. Open 5 days a week with no after-hour emergencies. (FL20H) FL, Lee County: SA, 1.25 DVM Prx. $1M+ 2020 gross. 4,000 SF building on app. 1 acre w/ 3 exam rooms. RE included. (FL25F) GA, South Atlanta Area: Solo SA, App. 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 with increasing revenues. Convenient to Charlotte, Winston-Salem, and Greensboro. Prx & RE. (NC20Y) NEW LISTING! NC, Crystal Coast Area: Located near the Neuse River, 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

PRSRT STD U.S. Postage PAID Orlando, FL Permit #793

WHEN IT COMES TO SELLING YOUR PRACTICE, GETTING THE BEST PRICE IS JUST THE FIRST STEP. PROTECTING YOUR LEGACY SHOULD GUIDE THE JOURNEY. Your practice is worth more than just a building with equipment. Its value includes your dedicated team, carefully crafted culture, and personal commitment to pets and their families.

That is why we approach selling your practice with the goal of ensuring you receive a maximum return and that your legacy continues.

Whether you’re considering a private or corporate sale, partner with the experts to navigate the process.

42 Years | 3,200 Sales Transactions | 12,000 Practices Appraised

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

Learn more at simmonsinc.com