FVMA Advocate Issue 6, 2019

F V M A ADVOCATE ISSUE 6 | 2019

FROM THE EXAM ROOM TO THE DENTAL TABLE Pg. 10

Denise S. Rollings, CVT, VTS (Dentistry)

GETTING THE RIGHT INFO ON PO: WHAT'S NEW WITH PARVOVIRUS Pg. 23

Garret Pachtinger, VMD, DACVECC THE

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FVMA ANNUAL CONFERENCE

MARCH 12-15, 2020

HILTON ORLANDO BONNET CREEK & WALDORF ASTORIA ORLANDO | ORLANDO, FLORIDA Located at official Walt Disney World® Resort hotels!

More details inside!

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

OFFICERS

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

DISTRICT REPRESENTATIVES Dr. Scott Richardson District 1–Big Bend Dr. Thomas E. Hester District 2–Northeast Dr. Todd Fulton District 3–Central Dr. Rachel Klemawesch District 4–Tampa Bay Dr. Susan M. Carastro District 5–Treasure Coast Dr. Marta P. Lista District 6–South Florida Dr. Barbara Lewis 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

It’s been another productive year for the veterinary community in Florida. Your FVMA has been actively representing you through various platforms, throughout the entire state! Our association has grown and can readily respond to any threat to the veterinary profession. Unfortunately, threats have become a common occurrence. The Association’s presence gives us tools to quickly neutralize many of these threats in our state.

Recently, Florida legislators have begun contacting the FVMA regarding bills that impact the veterinary profession and animal health, welfare, and well-being. This was not always the case. I believe through member participation in Legislative Action Days and grassroots exposure, the FVMA has paved the way for this luxury. Legislative Action Days was one of the most eye-opening events that I have participated in with the FVMA. Seeing veterinarians discussing and fighting for what we believe in with confidence and passion was inspiring, and it made me realize that educating governmental officials about the good, bad and ugly of how proposed changes affect us is extremely important. There is power in numbers. By numbers, I mean participants and dollars. One example of our legislative initiatives on your behalf was a compounding bill. This bill alone allows us to more effectively treat our patients. This is your FVMA at work.

We, as an association, want to continue to protect and promote our profession by having an influence and presence with legislative officials. In order for this to continue, we need those of you that have friends in important positions or know someone that knows someone in an important position to make connections and be heard. Getting our voices heard can empower us. Let those in power know that we stand together and want to be the most progressive profession possible. We will work hard to ensure that those who want to downplay and dismiss what we do will not prevail. Support legislators who support us and help them be our voice at the government level.

Public awareness methods are constantly evolving. We are currently integrating our profession within an ever-evolving social media presence as to provide public awareness for issues at hand among all media facets. We want to be the first source of information for the consumer, not the last.

By protecting public health and providing public education about how we protect all animals, I believe we will strengthen the confidence of the general public in our profession.

Membership in our association is vital and every one of you matter. Providing support and programs to our membership ensures all disciplines are represented, strengthening our association and encouraging new members. The FVMA provides a network of resources to aid in all stages of veterinarians’ careers, from entry to retirement and everything in between. Veterinary medical professionals are no strangers to struggles within the profession, such as financial, legal and mental health concerns.

As an association, we want to ensure we provide support to those who reach out for help.

I have introduced you to some identifiable needs in our strategic plan, yet these are just a few of the many. We as an association need to improve on informing our membership of what we do. I can assure you that we are focused on providing for our members, and we will do so for many years to come.

As my time as president ends soon, I want to thank you ahead of time for allowing me to represent you as your president of the FVMA.

Michael Epperson, DVM

FVMA MISSION:

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

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

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In Remembrance Gregory Bossart, VMD, Ph.D. FVMA out-of-state member Dr. Gregory Bossart, 68, passed away on Nov. 19, 2019, after a courageous battle with cancer. Dr. Bossart was a pathologist, veterinarian and scientist whose vast legacy of work included nearly 200 peer-reviewed articles and book chapters focusing primarily on the pathologic basis of disease in wild animals. His research efforts increased the public's knowledge and understanding of marine mammals, as well as resurgent and emerging diseases in dolphins, manatees, birds and whales. His groundbreaking work helped characterize the first viral diseases in manatees and led him to develop the first immunohistochemical technique for diagnosing brevetoxicosis (red tide poisoning) in both marine mammals and birds.

Dr. Bossart received his VMD from the University of Pennsylvania School of Veterinary Medicine in 1978. He also spent time at the University of Miami Miller School of Medicine as a comparative pathology resident, an adjunct professor and a National Institutes of Health fellow in the school’s Department of Pathology. Dr. Bossart founded the Avian & Wildlife Laboratory at UM in 1993, and he completed his Ph.D. in immunology at Florida International University in 1995. He worked in private veterinary practice early in his career and eventually became a clinical veterinary consultant at facilities in the U.S., Latin America and Asia.

His research projects led him to work collaboratively with the National Marine Fisheries Service, the National Ocean Service, the Florida Wildlife Research Institute, the National Institute of Environmental Health Sciences and the Office of Naval Research. At the time of his passing, Dr. Bossart was the senior vice president and chief veterinary officer at the Georgia Aquarium in Atlanta, where he oversaw animal care, research and conservation programs. He was also the principal investigator of the longstanding dolphin Health Environmental Risk Assessment (HERA) Project at the aquarium. Dr. Bossart remained an active leader in the veterinary community, serving as a Diplomate of the American College of Veterinary Pathologists (Hons), an adjunct professor in the Department of Pathology at the University of Georgia College of Veterinary Medicine, an affiliate professor at Harbor Branch Oceanographic Institute at Florida Atlantic University and on the graduate faculty at The Medical University of South Carolina.

In recognition of his many accomplishments, Dr. Bossart was awarded the 2019 William Medway Award for Excellence in Teaching by the International Association for Aquatic Animal Medicine, the Dean’s Clinical Research Award for his work at the University of Miami Miller School of Medicine, the Distinguished Alumni Torch Award from Florida International University and the Alumni Award of Merit from the University of Pennsylvania’s School of Veterinary Medicine. His dedication to conservation and commitment to advancing the understanding of marine animals will reverberate in the veterinary, wildlife and marine communities for years to come.

In This Issue 3 | In Remembrance 4 | Member Spotlight 6 | Wellness & Well-being: The Forefront & Future of the FVMA’s Goals 8 | The 13th Annual Dr. Harvey Rubin Memorial Food Animal Veterinary Medical Conference 10 | From the Exam Room to the Dental Table

14 | The 91st FVMA Annual Conference 23 | Getting the Right Info on PO: What's New With Parvovirus 26 | Practice Pulse 28 | Classified Advertisements 30 | Thank You LAD 2020 Delegates!

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MEMBER SPOTLIGHT FAEP past president, Executive Council member installed on AAEP Board FAEP Past President and current Executive Council member Dr. Amanda House was installed onto the American Association of Equine Practitioners’ (AAEP) Board of Directors at the AAEP’s 65th Annual Convention in Denver on Dec. 10, 2019. Dr. House was on the FVMA Board of Directors as the FAEP Council Representative to the Board from 2014-2017. Her term on the AAEP Board will conclude in 2022.

Dr. House currently serves on the AAEP’s Infectious Disease Committee. She sits on the Mentorship Subcommittee and moderates the Infectious Disease Round. She served as president of the FAEP Executive Council in 2010, and she now sits on the Executive Council as a member. Dr. House is also a part of the FAEP Educational Program Advisory Committee.

Dr. House currently serves as the director of the Practice-based Equine Clerkship Program, which is a part of the Large Animal Clinical Sciences program at the UF College of Veterinary Medicine. This program allows students to rotate between private practitioners, while getting on-farm, primary care experience with horses. She also spent eight years as a faculty adviser for the student chapter of the AAEP. Her clinical interests include neonatology, infectious disease, animal welfare and preventative medicine.

Dr. House completed her Bachelor of Science in animal science from Cornell University. She then graduated in 2001 from the Cummings School of Veterinary Medicine at Tufts University. After veterinary school, she completed an internship and large animal internal medicine residency at the University of Georgia’s Veterinary Teaching Hospital.

While working with the AAEP, Dr. House will be able to connect with more than 5 million horse owners worldwide. She will be actively involved with fighting ethics issues, defending practice management, conducting research, and continuing education in the equine veterinary profession and horse industry.

UFCVM appoints FVMA-FAEP dual member as interim dean

In 2010, Dr. Zimmel became chief of staff of UF Veterinary Hospitals in 2010, which was a role created as a part of UF Health’s strategic plan at the time. In 2012, she spurred the effort to create UF Pet Emergency Treatment Services (PETS) in Ocala, Florida. This clinic provides a compassionate environment for critically ill animals and their families, particularly during time periods when veterinarian’s offices are typically closed.

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“We’re excited about the appointment of Dr. Zimmel to the position of interim dean of the UF College of Veterinary Medicine and what her wealth of knowledge can bring to the future of UFCVM and its mission,” said FVMA Executive Director Phil Hinkle.

“We look forward to continuing to work with UFCVM under the leadership of Dr. Zimmel and grow our long-lasting relationship with its faculty, students and graduates.”

Photo courtesy of the UFCVM website

There’s a new head gator at the University of Florida College of Veterinary Medicine. FVMA-FAEP dual member Dr. Dana Zimmel has been named interim dean of the UFCVM. Dr. Zimmel was serving as associate dean of clinical services before being appointed to this position. She also is a proud alumna and graduate of the College’s Class of 1995. Dr. Zimmel became an employee of the UFCVM in 2002, beginning in UF/IFAS Extension, then moving onto large animal medicine and later progressing into leadership roles.

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Wellness & Well-being

THE FOREFRONT & FUTURE OF THE FVMA’s GOALS Philip Richmond, DVM, CHC-BCS, CCFP

In May 2018, the FVMA’s Executive Director Phil Hinkle and I discussed forming a committee to serve Florida’s veterinary professionals’ wellness and well-being needs and concerns. Soon after, Mr. Hinkle presented the idea to FVMA leadership. Later that summer, the FVMA Executive Board, led by then-FVMA President Dr. Marc Presnell, approved the formation of the FVMA Professional Wellness and Well-being Committee (PWWC).

Our FVMA leadership, including current FVMA President Dr. Michael Epperson and President-elect Dr. Mary Smart, continue to give the committee strong support. This support has allowed us to complete several projects and goals.

Since its inception, I’ve had the privilege of serving as chair of the committee. Our committee members are Drs. Juan Samper, Dani McVety, Nanette Parratto-Wagner, Cherie Buisson, Kelly Brady and Jamie Stahl. The PWWC, FVMA leadership and FVMA staff have worked together since the committee’s inception to offer the following for Florida’s veterinary professionals: 1. FVMA website: Content includes wellness and well-being topics, addiction resources, suicide prevention sites, mental health self-assessments, veterinary-specific mental health sites and various support groups. There’s also a list of mental health professionals in major city centers (and some rural areas) who have extensive experience working with medical professionals in the areas of burnout and compassion/ethical fatigue.

2. Social media resources, The Advocate & online webinars: The FVMA’s Communications Department has put out meaningful and impactful content in the FVMA’s bimonthly publication, The Advocate. Articles from members of the PWWC have been published in The Advocate, and we have provided information and resources for articles written by the FVMA Communications Department. We plan on

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offering webinars on wellness and well-being topics, which will be available to members in the near future.

3. Wellness tracks at conferences: We bring nationally recognized speakers and educators in veterinary wellness and well-being to FVMA conferences. We have hosted an array of subject experts including: Dr. Elizabeth Strand, who is the founder of the veterinary social work program at the University of Tennessee College of Veterinary Medicine and a co-researcher on the Merck Veterinary Wellbeing Study; Dr. Jen Brandt, who is the AVMA director of wellbeing and diversity initiative; Dr. Cherie Buisson, an FVMA PWWC member and founder of A Happy Vet; and Dr. Heidi Allespach, who is a psychologist from the University of Miami’s Jackson Medical Center. At the upcoming 91st FVMA Annual Conference, there will be three mental health professionals presenting: Dr. Alexis Polles, who is the medical director for Florida Professionals Resource Network; Dr. Bree Montana from the VIN Foundation; and Dr. Jamie Stahl, who is a mental health professional for the University of Florida College of Veterinary Medicine (UFCVM). We now also offer live QPR Gatekeeper Suicide Prevention Certification workshops at all FVMA conferences.

4. CE requirements: Our committee has recently worked with Mr. Hinkle and the Florida Board of Veterinary Medicine to allow five hours of wellness and well-being CE. This does not add to the 30-hour requirement but allows for wellness courses to be used toward that total.

5. Mental health questions on Florida’s veterinary licensing application: On the veterinary licensing application, the Florida Board will be changing the mental illness licensing questions. This is a major win for our colleagues statewide.

Chief Medical Officer for the American Foundation for Suicide Prevention Dr. Christine Moutier emphasized, during the AVMA Wellbeing Summit, how the presence

of questions on state licensing applications regarding mental illness are a significant and proven barrier to seeking treatment. It was my pleasure to share our successful efforts with her. The PWWC’s proposal to the Board — including relevant studies supporting the removal of mental health questions on licensing applications — may also be able to serve as a model to other states to petition and improve the likelihood of veterinarians seeking mental health treatment, when needed.

6. EAP and MAP: Our committee is exploring the possibility of creating an employee assistance program or member assistance program. This would be an important, potential benefit of FVMA membership and allow members to quickly and efficiently access a mental health professional with just a phone call. I want to give a heartfelt thanks to Dr. Brooke Certa for putting a significant amount of her time and effort into this project.

7. Coordination/Cooperation with AVMA Wellness and other state organizations: At the 2019 AVMA Wellbeing Summit, Dr. Tim Kolb, who is the Ohio VMA Wellness Chair, and I were able to help facilitate a meeting with seven other state wellness representatives and chairs to begin collaborating on our collective programs to find best practices. Our goal was to figure out what is working best for each state and their members. It’s our intention to form a coalition to be of service to other state veterinary organizations that wish to implement their own wellness/ well-being program(s) and help get them started. We are currently assisting North Dakota and the District of Columbia VMAs with their efforts.

8. Coordination/Cooperation with UFCVM: I am on a committee for a model wellness curriculum project for UFCVM. Dean for Students and Instruction Dr. Juan Samper is the chair of this project. We hope this program will serve as a model for wellness and well-being education for all colleges/schools of veterinary medicine in the U.S. and Canada. An important part of this program will be each state’s veterinary organization and how they are able to serve their recent graduating members in the transition to practice. It’s our intention to present this model at the 2020 AVMA Wellbeing Summit and possibly the AAVMC and AVMA Annual Conferences.

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Our beloved profession has gone through some significant changes — and still faces serious challenges ahead. What doesn’t change, however, is this: At its core, veterinary medicine is still one of the most rewarding callings in society. Our committee’s hope is to empower our friends and colleagues with the tools to allow this to continue to be true for all of us. This hope is not only for those of us who practice veterinary medicine today but for our future colleagues who are studying long hours at schools of veterinary medicine or technology. It’s also for the kids. The one who is gently picking up an injured bird or wrapping the leg of their favorite stuffed animal, dreaming of someday helping those who cannot help themselves — that little boy or girl who still lives in the hearts of us all.

Philip Richmond, DVM, CHC-BCS, CCFP Dr. Philip Richmond is a graduate of the University of Florida College of Veterinary Medicine (UFCVM) and practices in New Port Richey, Florida.

He has been in recovery for more than 10 years and is passionate about helping and mentoring medical professionals in early recovery. He currently serves as the chair of both the FVMA Professional Wellness and Well-being Committee and the FVMA Outreach Committee. He is a member of the UFCVM Well-being Curriculum Committee. The committee was formed with the intention to teach wellness and well-being to veterinary students and create a model for veterinary wellness education in North America. He has served on the Board of Directors of the Florida Medical Professionals Group, an organization that supports medical professionals in recovery in the state.

Dr. Richmond is a published writer and speaker, a Certified Health Coach — Behavioral Change Specialist, Certified Compassion Fatigue Professional and a Certified QPR Suicide Prevention Gatekeeper Instructor. He has earned the Coursera/ Penn Foundations in Positive Psychology Specialization Certificate, the BerkeleyX Science of Happiness at Work Professional Certificate and the AVMA Workplace Wellness Certificate. He is currently on schedule for a Certificate in Applied Positive Psychology and becoming a Certified Resilience Trainer in June 2020. In 2019, Dr. Richmond received an FVMA Gold Star Award for his service to the organization and the veterinary profession.

He is married to Dr. Carla Channell, who is also a veterinarian. They have two children, three dogs (an Aussie, a Beagle-Dachshund mix and a Maltese-Affenpinscher mix), a bevy of cats and turtles, a sulcata tortoise, a ball python and a corn snake. He is a Krav Maga practitioner, and he enjoys weightlifting and functional training.

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13

th ANNUAL

Dr. Harvey Rubin

Memorial Food Animal Veterinary Medical Conference

March 21-22, 2020 Register by March 6 and save!

 15 CE credits  $225 pre-registration (includes two lunches and a steak dinner)  $250 on-site registration (no meal tickets guaranteed)  FREE for CVM Students (pre-registration is required) The Florida Department of Agriculture and Consumer Services, Division of Animal Industry; pharmaceutical and animal food industry partners; and the Florida Veterinary Medical Association invite you to attend the 13th Annual Dr. Harvey Rubin Memorial Food Animal Veterinary Medical Conference.

Our program provides 15 hours of continuing education obtained through quality food animal informational lectures presented by specialists in the field of food animal veterinary medicine.

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We invite you to enjoy the steak dinner Saturday evening that also features native Southern foods, compliments of our industry partners. Without their support, we could not bring you this high-quality continuing education program.

To register, call the FVMA toll-free at 800.992.3862 or visit the FVMA website at www.fvma.org. On-site registration begins at 8:30 a.m. on Saturday, March 21 at the Osceola County Extension Building in Kissimmee, Florida.

SCHEDULE AT-A-GLANCE

Registration Desk Hours

Saturday, March 21, 2020 8:30 a.m. - 5 p.m.

Sunday, March 22, 2020 7:30 a.m. - 1:30 p.m

AGENDA*

Saturday, March 21, 2020 10:00 a.m. – 11:00 a.m. Introductions & Welcome – Dr. Lisa Conti, FDACS FDACS/Bronson Animal Disease Diagnostic Lab Update – Dr. Michael Short, FDACS, DAI 11:00 a.m. – 11:50 a.m. USDA Update – USDA-APHIS-VS 12:00 p.m. – 1:00 p.m. Lunch (subs and wraps, plus snacks) FVMA Welcome – Dr. Michael Epperson, FVMA Past President UFCVM Update – UFCVM 1:10 p.m. – 2:50 p.m.

FL Laws & Rules Governing the Practice of Veterinary Medicine – Edwin Bayó, Esq. 3:10 p.m. – 4:00 p.m. Dispensing Legend Drugs – Edwin Bayó, Esq. 4:00 p.m. – 4:50 p.m.

Biocontainment – Disease Control in the High-risk Stocker – Dr. Che Trejo, Zoetis 5:00 p.m. – 6:30 p.m.

Social Hour and Hotel Check-in 6:30 p.m. – 7:00 p.m.

Steak Dinner Served at FCA Headquarters 7:00 p.m. – 9:00 p.m.

FCA Welcome – Matt Pearce, Florida Cattlemen’s Association

EVENT LOCATIONS Osceola County Extension Building (next to the Silver Spurs Arena) 1921 Kissimmee Valley Lane Kissimmee, FL 34744 Florida Cattlemen’s Association 800 Shakerag Road Kissimmee, FL 34744 (Saturday’s Social Hour, Dinner, Cases & Roundtable Events)

Verification and Marketing Programs - Opportunities and the Future - WhereFoodComesFrom.com team

Sunday, March 22, 2020 8:00 a.m. – 8:10 a.m.

8:10 a.m. –9:00 a.m.

Welcome/ Housekeeping

9:00 a.m. – 9:50 a.m.

University of Georgia College of Veterinary Medicine

Trace Minerals Effect on Bovine Immune System

– Dr. Roberto Palomares,

Rumen Function – The Healthy Rumen – Dr. T.G. Nagaraja, Kansas State University

Break 10:10 a.m. – 11:00 a.m. Rumen Dysfunction – Dr. T.G. Nagaraja, Kansas State University 11:00 a.m. – 11:50 a.m. Reproductive Synchronization: Putting it all Together – Dr. Stephen Foulke – Boehringer Ingelheim 12:00 p.m. – 1:30 p.m. Lunch (pizza and snacks) Electronic Options, Compliance – Dr. Diane Kitchen, FDACS, DAI New Bio-tech Spotlight - Cattle Immune Health Testing

– Nano Discovery Inc. 1:30 p.m. – 2:20 p.m.

Accreditation Module 2 – Role of Agencies and Animal Movement Forms – USDA, APHIS, VS Break 2:40 p.m. – 3:30 p.m.

Accreditation Module 31 – High-impact Equine Diseases

in the U.S. – USDA, APHIS, VS

Past Sponsors

Additional support provided by

*Preliminary program subject to change.

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From the Exam Room to the Dental Table Denise S. Rollings, CVT, VTS (Dentistry) Veterinary dentistry isn’t just about cleaning teeth or getting rid of bad breath. A dental procedure is an anesthetized procedure that requires trained and educated veterinarians and veterinary technicians. Dentistry should be treated like every other anesthetized procedure that takes place in the veterinary hospital.

Only veterinarians can diagnose disease, but the veterinary technician plays a major role in assisting the veterinarian. The veterinary technician assists by obtaining an accurate history, recognizing pathology and bringing it to the veterinarian’s attention. The veterinary technician can be trained to perform a proper and thorough dental cleaning and to obtain diagnostic dental radiographs. Periodontal disease is the top disease diagnosed in dogs and cats, where 80% of all dogs and cats over the age of 3 have some stage of periodontal disease. Every patient should be receiving routine dental care. The following procedures outline the steps of the dental procedure day.

The Pre-anesthetic Exam

Oral History and Oral Exam: Look for and ask the owner about things, including bad breath; swollen, red or bleeding gums; excessive drooling; and changes in eating or chewing habits including dropping food, going to the food but not eating, vocalizing while eating, teeth loss and the disinterest in toys.

Often, pets show no signs of pain. Find out what the pet chews on and how the family takes care of the pet’s dental needs at home.

A patient may avoid a toy or a particular food due to pain, and the owner may perceive it as the pet not liking that item anymore.

The Day of the Procedure Perform another physical exam upon admission including a temperature, pulse rate and respiration rate check (TPR) and hydration status check. Make sure you get all phone numbers and emergency contacts. Tell the owners they must be able to be reached and have someone else as back up to make decisions on their behalf. Know the owners’ wishes and have it in writing, in case of an emergency.

The technician should review the treatment plan, estimate and review consent forms, again, with the client. The treatment plan should be as accurate as possible, and the technician should go through it with the client line by line. One can use pictures, models, skulls, videos and charts to explain the procedure, pathology and importance of the treatment. There should be a low and high range on the estimate in case of a worst-case scenario.

This will help prevent stress to the client and staff over unexpected expenses. Take a deposit for the low end of the estimate in the morning and take care of the difference at discharge.

Blood Work: A lot of our patients are geriatric, and we need to make sure there isn’t underlying disease. Age is not a disease. Age can predispose our patients to having coexisting disease. Ideally, lab work should be done before the day of the procedure in case there are abnormalities found. Having the lab work completed ahead of time will prevent a procedure from being cancelled the day of due to abnormalities. It will also allow the patient to be treated for the abnormalities ahead of time and allows that patient’s protocol to be tailored to his or her needs. A chemistry panel, complete blood count, +/- coagulation panel, urinalysis, chest radiographs, echocardiogram, ECG and blood pressure should be considered for evaluation.

Client Communication: It takes a person three times to hear something before it sinks in. The doctor discusses it, the technician goes over it with paperwork, and the client service representative mentions it again and offers to schedule the appointment. Hand out a dental report card, pamphlet and/or treatment plan. Greenies™ and Virbac have premade report cards so you don’t have to make your own. If you aren't ready to take on making your own, use what’s available. Don’t reinvent the wheel.

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An anesthetist and technician performing four-handed dentistry.

Photo courtesy of Denise S. Rollings

The doctor and technician should review the history and lab results. An American Society of Anesthesiologist (ASA) Physical Status Scale should be assigned to each patient. A Class I would be a normal, healthy patient with no underlying disease and minimal risk. A Class II is a patient with mild systemic disease, putting him or her at a slight risk, but the animal is able to compensate. A Class III means there is an obvious disease present with moderate risk. A Class IV means the animal is significantly compromised by severe systemic disease, and there is high risk. A Class V is when there is life-threatening systemic disease presenting an extreme risk, and the patient is approaching death.

An anesthesia plan, including pain control, should be tailored for every patient based on that patient’s needs and health status.

Anesthesia should not be "cookie-cutter." Pre-, intra-, post- and at-home pain medication equals a multimodal approach to pain management. Premedicants can be a sedative that will help reduce stress in the fearful patient. During the procedure, opioids allow for lower inhalant anesthesia because of the analgesic properties.

Protocols should be based on the patient’s information, PE, workup status and temperament, and pre-existing conditions. As mentioned earlier, age is not a disease. An induction agent should be selected as well because all patients need to be intubated.

Nerve blocks can be used intraoperatively to help reduce the amount of inhaled gas anesthesia used and help our patients have a smoother anesthetic procedure and recovery. A nonsteroidal anti-inflammatory can be considered on an individual basis.

Full-mouth dental radiographs being performed as part of a comprehensive oral exam.

Protecting Yourself

Personal Protection Equipment (PPE): Wear eye protection!

Goggles, loupes or a visor should be worn by everyone in the operatory area, as pieces of calculus, tooth, bone, blood, saliva and even broken burs become airborne and can cause an eye injury or infection. A surgical face mask that covers the mouth and nose should be worn. Anti-fog masks are helpful in preventing protective eyewear from fogging up. Appropriately fitted gloves and protective clothing, such as a surgical cap and a gown or lab coat, should be worn to prevent bacterial contamination of your clothing and hair. Consider using hearing protection if the noise of the dental unit running is bothersome.

Ergonomics is an applied science concerned with designing and arranging the things people use so that it is efficient and safe. Dentistry is a lot of small, repetitive movements that can strain our muscles, tendons and ligaments. In order to protect ourselves from fatigue and short- or long-term injury, we should practice the best ergonomics possible. Lift tables will adjust to an individual, and this allows for the arms to be parallel with the table. A dental saddle seat allows one to sit with their back straight, thighs slightly angled to the floor and gaze looking down, not bending over. Utilizing a modified pen grasp when holding instruments reduces the strain of repetitive movements. Fatigue mats can be used if one is standing for long periods of time

Patient Monitoring

Nothing replaces a qualified person who can assess values, interpret changes and intervene when needed. Several parameters

Photo courtesy of Denise S. Rollings

should be monitored; however, the equipment should never be a substitute for hands-on human monitoring.

Heart Rate: Use a stethoscope to auscultate the heart sound and check the pulses manually. Pay attention and make note of the strength of the pulse. Quality is as important as quantity.

Respiration: Evaluate both quantity and quality. Respiratory failure can lead to cardiovascular failure. Check the mucous membrane color and capillary refill time. An increased respiratory rate could mean light anesthetic depth and decreased respirations could mean a deep anesthetic plane. Measures should be taken to correct both.

Blood Pressure: Hypotension is a very common complication of anesthesia but that doesn’t mean it’s OK. Hypotension needs to be addressed and corrected, as needed. Blood pressure can change due to the depth of anesthesia, shock, strength of cardiac contraction and blood volume. Systolic pressure should stay about 80-90 mmHg, and the mean arterial pressure should stay above 60 mmHg to make sure the vital organs receive adequate profusion. Intravenous fluids and decreasing anesthetic depth can help perfusion.

End Tidal Carbon Dioxide: A capnograph measures the end tidal (ET) carbon dioxide level in the patient. It allows for assessment of ventilation over time using a graphic display.

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Intravenous Fluids: Keep patients on an IV fluid pump to ensure they are receiving the proper amount of intravenous fluids and helping to prevent an accidental fluid overload. Monitor the fluid rate and change as needed. Use an appropriate rate of 2-10 ml/kg/hr based on health, hydration and blood loss of the patient.

Decrease the fluid rate for patients with cardiac disease.

Steps to the Complete Dental Procedure

There should be a qualified technician monitoring anesthesia and a qualified technician performing the dental procedure. It is not safe for one technician to be doing both. Neither job can be performed correctly or safely if one person is doing both.

Start with a pre-intubation exam. Check the occlusion of the patient before intubation. Once the patient is intubated, the endotracheal tube will prevent the mouth from closing. Take pictures of the occlusion so there’s a reference to look at, if attrition is found on the complete oral exam. Note any asymmetry of the head and muscles, look for draining tracts, and check lymph nodes and skin around the mouth. Open the mouth to check the range of motion before induction.

Occlusion check.

Photo courtesy of Denise S. Rollings

The end tidal CO2 should be between 35-45 mmHg. Common problems include the improper placement of the endotracheal tube, a leaking cuff of an endotracheal tube or apnea, to name a few.

Electrocardiogram (ECG): An ECG should be continuously monitored so that any changes or abnormalities in the electrical changes or heart rate can be recognized early.

Pulse Oximetry: Pulse oximetry measures the arterial oxyhemoglobin saturation. Oxygen saturation should be between 98-100%. The causes of saturation of 90% or less include hypovolemia, anemia, shock, probe becoming dislodged, low respirations or poor ventilation.

Temperature: Be sure to monitor temperature and keep patients warm. Our patients become very wet during a dental procedure and, therefore, are at risk of hypothermia. Monitor temperature throughout the entire procedure. It is easier to maintain temperature than try to warm them up once they are cold. Cold pets become hypotensive, bradycardic, and could develop arrhythmias and hypothermia, which, in turn, can decrease kidney function, prolong recovery and prolong healing.

Use warm air heaters and circulating water blankets. Be sure to wrap the pet’s feet and keep them as dry as possible. Check the temperature of the warming devices as well. Do not put pets at risk for thermal burns and do not leave an unconscious animal on heat without being monitored.

12 | FVMA ADVOCATE

Once the pet is under anesthesia, take photos before cleaning the teeth. Check all surfaces of the teeth and note any calculus, plaque and missing teeth. Check the buccal mucosa, tongue and palate for any abnormalities, including granulomas, chewing lesions, lacerations, ulcerations or oral masses. Rinse the oral cavity with 0.12% chlorhexidine solution. This reduces the number of bacteria the staff and patient are exposed to during the procedure. Leave the solution on for a few minutes or brush the teeth with it before starting. Remove any supragingival plaque and calculus. This is most important to the owner because it is what they see; however, it’s the least important to the health of the patient. Begin with the powered (ultrasonic, magnetorestrictive or piezo) scaler. Do not spend more than 10 seconds on a tooth at a time and be sure you are using enough water to cool and irrigate the tooth. Remove the subgingival plaque and calculus with a curette or perio tip. This is the least visible to the owner but the most important to the health of the patient. Plaque bacteria are the cause of periodontal disease, not calculus. The plaque must be removed from any subgingival space. Check your work. Use the air water syringe to rinse the mouth of calculus and blood, then use the air water syringe to dry the teeth. Look for any chalky white residue that remains on the teeth as that’s the calculus that has been missed. Remove what is left with a hand scaler and/or curette. Polish the teeth using fine- or flour-grade paste above and below the gum line. Flare the polishing cup under the gingival sulcus. Use a light touch and spend only five to 10 seconds or less per tooth. Polishing smooths the tooth surface and removes irregularities created by scaling. This decreases the surface area for plaque bacteria to stick to. Once all the calculus and plaque have been removed and the teeth are polished, rinse the tooth surface and sulcus to remove debris and paste. At this point, some like to apply fluoride. Fluoride can decrease sensitivity. Do not use in renal patients because fluoride is excreted through the kidneys and these patients cannot spit it out.

One must obtain full-mouth radiographs. Radiographs are a must, and they’re part of the comprehensive oral exam. We can see the crown and determine periodontal pockets, but we can’t see what’s there. Radiographs tell us if a tooth can be repaired or if it needs to be removed. This is an extra diagnostic tool. Most pathology is below the gum line, where 80% of the dental anatomy is not visible. Radiographs must be obtained post-extractions, as well.

Charting: For charting, use four-handed dentistry. The doctor performs a complete oral exam using a probe and explorer, and the technician documents the findings. A technician can be trained to perform a complete oral exam; however, a veterinarian must diagnose if there is pathology. Probe every single tooth. Walk the probe around the entire tooth and measure pocket depth.

The explorer is run along the gum line, on the tooth surface, and occlusal surfaces to check for imperfections. It’s very tactile, and one will feel the “ping” or stickiness. Note all furcation exposure, mobility, gingival recession, enamel defects, fractures, tooth resorption, oral masses and caries.

A treatment plan should be customized for each tooth in every patient based on the complete oral exam, probing and intraoral radiographs. Surgery, extractions and advanced dental procedures must be performed by a veterinarian. Take post-procedure photographs of both sides and cover the endotracheal tube with the tongue so it doesn’t look too scary to the owner in the picture.

During anesthetic recovery, check the patient’s temperature, blood pressure, and heart and respiratory rate postoperatively. Most of our dental patients are not young, spay-and-neuter patients. They are geriatric and may be compromised, so watch them closely.

Be sure to clean their faces. Do not send a wet, bloody-faced pet home. Rinse the face and dry it thoroughly. Keep them comfortable, and do not let them sit in urine or feces. Return them to their owner in almost the same condition (or better) as when they arrived. Enter charges for the procedures performed, and charge for the time you and the veterinarian spent. Transfer the pre- and post-pictures and radiographs to be printed or emailed to the owner. Offer to print and/or email the pre- and post-pictures, as well as the radiographs, to the owner.

Discharge Instructions: When it comes to discharge instructions, personalize them based on the individual’s condition, and make sure to include feeding instructions, medications and recheck dates. Have the directions and instructions for medications go home in writing for the owner. It should include when the owner should start the medications, how often to give them, how many to give, what the medication is for and how many days they must take it. If oral surgery was performed, the pet needs to be rechecked to ensure all sites are healed anytime between seven to 14 days, postoperatively. They should also come back in three to 12 months for an oral exam. This is determined by the extent of periodontal disease present and the breed of the animal. Toy breeds are more predisposed to have periodontal disease than large or giant breed dogs. Discuss this with the owner and put dates in the computer to generate a reminder for future appointments.

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Discuss home care with the owner when they bring the pet back for the follow-up exam. They are usually overwhelmed at the time of surgery and may not comprehend the conversation. Send a packet home with samples of all the products you carry that may be appropriate for that patient.

Explain what they are and how they work. Now that the teeth are nice and clean, we need to keep them that way. Don’t pat yourself on the back yet, though, because bacteria are already multiplying as they are walking out the door. Educate the client on the importance of home care to help protect their investment. Proper dentistry takes a team, but it can be achieved with the hopes that we can improve the lives of pets, one tooth at a time.

References

Blackwell’s Five-Minute Veterinary Consult Clinical Companion Small Animal Dentistry. Lobprise, Blackwell Publishing; Ames; 2007.

Small Animal Dental Procedures for Veterinary Technicians and Nurses. Perrone; Wiley-Blackwell; Ames; 2013.

Veterinary Dentistry for the Small Animal Technician. Kesel, Blackwell Publishing Company; Ames; 2000.

Veterinary Dentistry for the Technician and Office Staff. Holstrom; Saunders: Philadelphia; 2000.

Denise S. Rollings CVT, VTS (Dentistry) Denise S. Rollings received her Associate of Applied Science in veterinary technology from Madison Area Technical College in 2001, graduating with honors. She became a veterinary technician specialist in dentistry through the Academy of Veterinary Dental Technicians in 2014. In 2017, Rollings founded Pet Dental Education, LLC, offering on-site training in various aspects of veterinary dentistry for veterinary hospitals nationwide. She also has worked as a dental educator for several companies. Following her passion for teaching and inspiring others, Rollings is now a full-time educator for Pet Dental Education, LLC. Rollings has nationally and internationally lectured and taught labs on topics ranging from veterinary dentistry to improving standards of dentistry at individual animal hospitals. She has a passion for veterinary dentistry and strives to ignite that passion in others. She’s a firm believer in improving the quality of our pets’ lives, one tooth at a time.

THE FVMA |

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91

THE

Your invitation to attend

st

HILTON ORLANDO BONNET CREEK &

IT'S NOT TOO

WORLD-CLASS CONTINUING EDUCATION FOR

FVMA ANNUAL CONFERENCE

MARCH 12-15, 2020

WALDORF ASTORIA ORLANDO

Located at official Walt Disney World® Resort hotels!

LATE TO REGISTER!

EVERY MEMBER OF THE VETERINARY TEAM!

Engaging, Hands-on W

DENTISTRY

ULTRASOUND BASIC SMALL ANIMAL ABDOMINAL ULTRASOUND

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THURSDAY, MARCH 12 | 8:00 A.M. - 12:00 P.M. Tony M. Woodward, DVM, DAVDC R. Michael Peak, DVM, DAVDC

DV

DV

FELINE EXTRACTION TECHNIQUES

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THURSDAY, MARCH 12 | 8:00 A.M. - 5:00 P.M. Kenneth R. Waller III, DVM, MS, DACVR

With Conf. Reg. Fee: Vets $475 | Wet Lab Only Fee: Vets $675

With Conf. Reg. Fee: Vets $450 | Wet Lab Only Fee: Vets $650

THURSDAY, MARCH 12 | 1:30 - 5:30 P.M.

DV

DV

CANINE EXTRACTION TECHNIQUES

ADVANCED SMALL ANIMAL ABDOMINAL ULTRASOUND

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AV LI AI MIT LA ED BI LIT Y

FRIDAY, MARCH 13 8:00 A.M. - 5:00 P.M.

Tony M. Woodward, DVM, DAVDC R. Michael Peak, DVM, DAVDC

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Kenneth R. Waller III, DVM, MS, DACVR

DV

DIFFICULT EXTRACTIONS AND RETRIEVAL OF FRACTURED ROOT TIPS

VETERINARY POINT-OF-CARE ULTRASOUND FOR EVERYDAY PRACTICE

M

DV

With Conf. Reg. Fee: Vets $475 | Wet Lab Only Fee: Vets $675

With Conf. Reg. Fee: Vets $450 | Wet Lab Only Fee: Vets $650

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SATURDAY, MARCH 14 | 8:00 A.M. - 5:00 P.M.

Tony M. Woodward, DVM, DAVDC R. Michael Peak, DVM, DAVDC

Søren Boysen, DVM, DACVECC Serge Chalhoub, BSc, DVM, DACVIM (SAIM)

With Conf. Reg. Fee: Vets $450 | Wet Lab Only Fee: Vets $650

With Conf. Reg. Fee: Vets $495 | Wet Lab Only Fee: Vets $695

FRIDAY, MARCH 13 1:30 - 5:30 P.M.

Denise S. Rollings, CVT, VTS (Dentistry) With Conf. Reg. Fee: Techs $95 | Wet Lab Only Fee: Techs $150

DENTAL NERVE BLOCKS, CLEANING, PROBING & CHARTING SATURDAY, MARCH 14 8:00 A.M. - 12:00 P.M.

Denise S. Rollings, CVT, VTS (Dentistry) With Conf. Reg. Fee: Techs $95 | Wet Lab Only Fee: Techs $150

IC I A

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AV LI AI MIT LA ED BI LIT Y TECHN

DENTAL RADIOLOGY POSITIONING & TECHNIQUES

TECHN

FRIDAY, MARCH 13 | 8:00 A.M. - 12:00 P.M.

IC I A

WET LAB SP

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AV LI AI MIT LA ED BI LIT Y

Limited seats remaining —

Wet Labs & Workshop

THURSDAY, MARCH 12 8:00 A.M. - 12:00 P.M. Randy Basinger, DVM, DACVS

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AV LI AI MIT LA ED BI LIT Y

OPHTHALMIC SURGERY

DV

With Conf. Reg. Fee: Vets $495 | Wet Lab Only Fee: Vets $695 M

THURSDAY, MARCH 12 | 10:00 A.M. - 5:00 P.M. Robert Swinger, DVM, DACVO

With Conf. Reg. Fee: Vets $475 | Wet Lab Only Fee: Vets $675 M

AV LI AI MIT THURSDAY, MARCH 12 | 1:30 - 5:30 P.M. LABIED LIT Randy Basinger, DVM, DACVS Y

With Conf. Reg. Fee: Vets $495 | Wet Lab Only Fee: Vets $695

PONSORS

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*SAME WET LAB OFFERED FOR AM AND PM SESSION.

FRIDAY, MARCH 13 | 8 A.M. - 12 P.M. (AM SESSION)* 1:30 - 5:30 PM (PM SESSION)* Andrew Mackin, BSc, BVMS, MVS, DVSc, FANZCVSc, DACVIM John Thomason, DVM, MS, DACVIM With Conf. Reg. Fee: Vets $295 | Wet Lab Only Fee: Vets $495

FIVE-MINUTE, FIVE-DOLLAR TESTS: “SPECIALIST” DIAGNOSTIC TECHNIQUES

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SATURDAY, MARCH 14 | 8:00 A.M. - 12:00 P.M.

Andrew Mackin, BSc, BVMS, MVS, DVSc, FANZCVSc, DACVIM Jeb Cade, DVM, MS

With Conf. Reg. Fee: Vets $95 | Wet Lab Only Fee: Vets $250 DV

MEDIAL PATELLA LUXATION

THE GREAT ENDOSCOPY ADVENTURE

DV

CRANIAL CRUCIATE WITH ORTHOZIP

DV

INTERNAL MEDICINE DV

SURGERY

Special CE Offerings  Suicide Prevention Certification

Friday, March 13, 2020 | 1:30-3:20 p.m.

Philip Richmond, DVM, CHC-BCS, CCFP Kelly Brady, LMHC, AP

Pre-registration required. Limited seating.  Dispensing Legend Drugs

Saturday, March 14, 2020 | 7-7:50 a.m.

Edwin Bayó, Esq.

 Florida Laws & Rules Governing the

Practice of Veterinary Medicine Sunday, March 15, 2020 | 7-8:50 a.m.

Edwin Bayó, Esq.

— reserve your seat today!

Resort & Venue Information HILTON ORLANDO BONNET CREEK

14100 BONNET CREEK RESORT LANE ORLANDO, FL 32821 P: 888.353.2013 • FVMA Special Rates: Starting at $235, plus taxes • Group rate extended stay three days pre- and post-conference, based on availability.

WALDORF ASTORIA ORLANDO

14200 BONNET CREEK RESORT LANE ORLANDO, FL 32821 P: 888.353.2009 • FVMA Special Rates: Starting at $285, plus taxes • Group rate extended stay three days pre- and postconference, based on availability.

All room rates quoted above are exclusive of applicable resort fees. There is an optional daily resort fee at the individual guest’s discretion. The resort fee is $45.00 per night, per room. Applicable state and local taxes will be posted to all guest rooms. The optional resort fee covers the following items, services and amenities: • Kids meals deals and discounts.

• Free golf club rental after 2 p.m.

• Daily water (two bottles).

• Unlimited in-room local and 1-800 calls.

• Access to golf club practice facilities.

• Lazy river tubes and cabana discount.

RESERVE YOUR ROOM TODAY!

SS C E LA H O UR S 31

EXCEPTIONAL

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C

CUTTING-EDGE LECTURES

HANDS-ON WET LABS

WOR LD RN UP TO EA

CH TE

NICIANS E A VE T

O 19 H UP T O RN RINARIANS U E

RS

PRESENTING MORE THAN 300 HOURS OF STIMULATING, QUALITY CONTINUING EDUCATION DELIVERED BY AN OUTSTANDING ARRAY OF DISTINGUISHED SPEAKERS IN AN ENVIRONMENT THAT ENRICHES THE ENTIRE VETERINARY TEAM!

Featured Speakers

MARK ACIERNO

MBA, DVM, DACVIM

LORE HAUG

CHAD JOHANNES

DVM, MS, DACVB

DVM, DACVIM (SAIM, ONCOLOGY)

R. MICHAEL PEAK

DVM, DAVDC

RICK ALLEMAN

LENORE BACEK

DVM, Ph.D., DABVP, DACVP

DVM, MS, DACVECC

STANLEY KIM

BVSc, MS, DACVS

SHEILAH ROBERTSON

BVMS (Hons), Ph.D., DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS

RANCE SELLON

DVM, DACVIM (SAIM, ONCOLOGY)

CHRISTINE CULLER

DVM, MS, DACVECC

TAMI LIND

BS, RVT, VTS (ECC)

ROBERT SWINGER

DVM, DACVO

MICHAEL D. WILLARD MICHAEL WONG

DVM, MS, DACVIM-SA

• • • • • • • • • • •

ANDREW MACKIN

BSc, BVMS, MVS, DVSc, FANZCVSC, DACVIM

TYLER WERNLI

DR. RANDY BASINGER EDWIN BAYÓ, ESQ. DR. SØREN BOYSEN DR. KELLY BRADY MEGAN BRASHEAR, BS, RVT, VTS (ECC) DR. ANDREW BUGBEE DR. JEB CADE DR. SERGE CHALHOUB DR. KIRSTEN COOKE DR. MATTHEW EVANS DR. KATHLEEN GELATT-NICHOLSON

GARY NORSWORTHY

DVM, DABVP (FELINE)

AMELIA WHITE

DVM, MS, DACVD

TONY M. WOODWARD

• • • • • • • • •

DR. ADAM GONZALES DR. SHANNON HOLMES DR. KELSEY JORGE DR. JESSICA MARTINEZ DR. AARON MASSECAR DR. BREE MONTANA REBECCA “BECKIE” MOSSOR, RVT CORT NORTON, CVT JEANNE PERRONE, CVT, VTS (DENTISTRY) • DR. ALEXANDRIA POLLES

 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 #0001682

ERIC GARCIA

DVM, DAVDC

DISTINGUISHED FACULTY

RACE APPROVED:

DVM, DACVIM (NEUROLOGY)

AMARA ESTRADA

DVM, DACVIM (CARDIOLOGY)

CE HOURS FOR:

• DR. PHILIP RICHMOND • DENISE S. ROLLINGS, CVT, VTS (DENTISTRY) • DR. ALFREDO ROMERO • DR. SCOTT SECREST • DR. JAMIE STAHL • DR. JOHN THOMASON • DR. KENNETH R. WALLER III • DR. STUART WALTON • DR. LINK WELBORN  Veterinarians - 31 credit hours maximum  Technicians - 19 credit hours maximum

(Your 2020 FVMA dues must be current to register at the discounted registration rate below.)

Phone:

Preferred Address:

Clinic Name:

Name:

Email:

TOTAL REGISTRATION FEE $

C

Signature

Expiration Date

FVMA | 7207 Monetary Drive • Orlando, FL 32809 | Phone: 800.992.3862 | Fax: 407.240.3710

$0.00

D

No Fee

Add $100 per registrant after February 11, 2020.

TOTAL SPECIAL EVENT/GUEST FEE $

 Saturday, March 14 Spring Fling (Pre-registration required.)

SOCIAL EVENTS  Friday, March 13 Award Ceremony & Installation of Officers No Fee  Saturday, March 14 FVMA Foundation Reverse Raffle (Win $2,500) ____ x 1 Ticket for $35.00 ____ x 4 Tickets for $100.00 = $ ____ (Four tickets must be purchased at the same time to qualify for discount.)

Child’s Name Child’s Name

(Children’s Registration does not include lunch)

Spouse/Guest Name  Children’s Registration (Ages 0-17)

SPOUSE/GUEST REGISTRATION  Spouse/Guest Registration

$125.00 Spouse/Guest Registration Includes:  Friday lunch  Spring Fling  All coffee breaks  Saturday lunch  Exhibit Hall access DOES NOT INCLUDE ACCESS TO CE

 Visa  Mastercard  American Express Discover

$

$250.00

$675.00 $650.00 Free $695.00

$475.00 $450.00 Free $495.00 $95.00

$675.00 $650.00 $650.00 $695.00 $695.00 $675.00 $495.00 $495.00

$475.00 $450.00 $450.00 $495.00 $495.00 $475.00 $295.00 $295.00

With Conf. Reg. Wet Lab Only

VETERINARIAN REGISTRATION FORM

Name as It Appears on Card

Credit Card Number

(U.S. funds drawn on U.S. banks)

$

TOTAL WET LABS/WORKSHOP FEE

Techniques That Are Actually Easy and Inexpensive

 Saturday, Five-minute, Five-dollar Tests: “Specialist” Diagnostic

WET LABS/WORKSHOP  Thursday, Basic Small Animal Abdominal Ultrasound  Thursday, Feline Extraction Techniques

 Thursday, Canine Extraction Techniques

 Thursday, Cranial Cruciate With OrthoZip

 Thursday, Medial Patella Luxation

 Thursday, Ophthalmic Surgery

 Friday, The Great Endoscopy Adventure* (AM session)  Friday, The Great Endoscopy Adventure* (PM session) *Same wet lab offered for AM and PM session.  Friday, Advanced Small Animal Abdominal Ultrasound  Friday, Difficult Extractions and Retrieval of Fractured Root Tips  Friday, Suicide Prevention Certification Workshop (Pre-registration required.)  Saturday, Veterinary Point-of-care Ultrasound for Everyday Practice

Method of Payment  Check/Money Order  Charge My Credit Card Below $

TOTAL PAYMENT (A, B, C, D)

B

AVMA-accredited veterinary school name (Proof of current enrollment required)

Includes CE (excluding those with additional fees), lunch on Friday and Saturday, non-ticketed social events, access to the Exhibit Hall and a digital copy of conference proceedings.  FVMA 2020 Member.......................................$575.00  Member, Graduated 2018-2019......................$100.00  Member, Graduated 2017...............................$400.00  Member, Graduated 2016...............................$450.00  Non-resident..................................................$575.00 (Current member of state VMA or military.)  Non-FVMA Member.......................................$700.00  Veterinary Student..............................................$0.00

REGISTRATION FEE

$

VETERINARIAN REGISTRATION

 My 2020 FVMA Membership is current.

A Total Membership Dues  I would like to join and take advantage of the discounted registration fee. I qualify for the following: Categories: (Please check one.)  Regular Member $275.00  Recent Graduate (within last two years) $153.00  State/Federal Employee $153.00  Part-time Employee $153.00 (Employed at FVMA Member practice & work 20 hrs per week or less.)  Non-Florida Resident $117.00

FVMA MEMBERSHIP

91ST FVMA ANNUAL CONFERENCE MARCH 12-15, 2020 HILTON ORLANDO BONNET CREEK & WALDORF ASTORIA ORLANDO ORLANDO, FLORIDA

91ST FVMA ANNUAL CONFERENCE MARCH 12-15, 2020 HILTON ORLANDO BONNET CREEK & WALDORF ASTORIA ORLANDO ORLANDO, FLORIDA

FVMA AFFILIATE MEMBERSHIP

B

Email:

TEAM MEMBER REGISTRATION Name: Clinic Name: Preferred Address: Phone:

A

Registration fee includes CE (excluding those with additional fees), lunch on Friday & Saturday, non-ticketed social events, access to the exhibit hall and a digital copy of conference proceedings.

Free

$150.00

Free

WET LABS/WORKSHOP  Friday, Suicide Prevention Certification Workshop (Pre-registration required.)

$95.00

With Conf. Reg. Wet Lab Only

 Friday, Dental Radiography Positioning and Techniques

C

$150.00

$

 Saturday, Dental Nerve Blocks, Cleaning, Probing & Charting $95.00

TOTAL WET LABS

$  Visa  Mastercard  American Express Discover Expiration Date Signature

Total Membership Dues

SOCIAL EVENTS

$

$

No Fee

D

Add $50 per registrant after February 11, 2020.

TOTAL SOCIAL EVENT FEES

 Saturday, March 14 Spring Fling (Pre-registration required.)

(Four tickets must be purchased at the same time to qualify for discount.)

______ x 1 Ticket for $35.00 = $ ____ ______ x 4 Tickets for $100.00 = $ ____

FVMA Foundation Reverse Raffle (Win $2,500)

 Friday, March 13 Award Ceremony & Installation of Officers  Saturday, March 14

No Fee

The FVMA offers affiliate membership to team members in the following categories: Certified Veterinary Technician (CVT) – graduates of AVMA-accredited veterinary technology programs who have passed the Veterinary Technician National Exam; dual certification/membership Certified Veterinary Assistant (CVA) - graduates of the FVMA’s CVA program; dual certification/membership Veterinary Practice Manager (VPM) – current or previously employed veterinary practice or hospital managers Animal Care Technician (ACT) - on-the-job-trained veterinary technicians with at least three years of experience.

Please visit www.fvma.org/team-members for applications to these entities.

$ 250.00

$ 200.00

 My 2020 FVMA Affiliate Membership is current.  I would like to join and take advantage of the discounted registration fee. My affiliate membership application is enclosed.

(Note: Incomplete applications may result in delayed membership and conference registration.) You may add your total membership dues to Box A to the right or pay separately on your application. CVT - $55, VPM - $55, ACT - $35

REGISTRATION FEE

Member Registration Fee  CVT  CVA  VPM  ACT Non-member Registration Fee  CVT  Technician/Assistant  Practice Manager  Admin Staff SPOUSE/GUEST REGISTRATION

$

 Spouse/Guest Registration................................................................................................$125.00 Spouse/Guest Registration Includes:  Friday lunch  Saturday lunch  Spring Fling  Exhibit Hall access  All coffee breaks DOES NOT INCLUDE ACCESS TO CE Spouse/Guest Name  Children’s Registration (Ages 0-17) (Children’s Registration does not include lunch).....................$0.00 Child’s Name Child’s Name TOTAL REGISTRATION FEE

TOTAL TEAM MEMBER PAYMENT (A, B, C, D)

Method of Payment  Check/Money Order  Charge My Credit Card Below $ (U.S. funds drawn on U.S. banks)

Credit Card Number Name as It Appears on Card

TEAM MEMBER REGISTRATION FORM FVMA | 7207 Monetary Drive • Orlando, FL 32809 | Phone: 800.992.3862 | Fax: 407.240.3710

protecting your veterinary license Your license is one of the most important assets you need to protect.

Don’t face complaints against your veterinary license alone.

Our Veterinary License Defense program helps veterinarians get the legal protection they deserve.

800-228-7548, option 2

avmaplit.com/vld

The Cat Thyroid Center The Gentle Cure for Hyperthyroidism •

• •

Specialized Treatment in a Warm, Homelike Environment.

Focus on Customer Service Excellence with Individualized Patient Care.

Over 20 Years of Experience.

Short, 48 Hour Stay.

•

98% Success Rate!

•

We are excited to announce Dr. Greg Heaton has joined our team.

Dr. Heaton, originally from Cincinnati, Ohio, obtained his Bachelor of Science degree in Chemistry and Psychology in 1999 from Valparaiso University. He received his DVM degree from Purdue University and is currently a member of the AVMA, FVMA, and AAFP. His calm, caring demeanor with our clients and feline patients in addition to his eye for detail make him a welcome addition to The Cat Thyroid Center.

“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, Sanlando Springs Animal Hospital in Longwood, FL

813.641.3425 • www.catthyroid@cs.com • 717 S. Tamiami Trail, Ruskin, FL 33570

Getting the Right Info on PO: What's New With Parvovirus

Garret Pachtinger, VMD, DACVECC Canine parvovirus (CPV) infection is a common problem in small animal medicine, both in general practice and in the emergency room. Although CPV is not new, as it was originally discovered in 1967, our treatment options and medicine have advanced. CPV remains a common pathogen affecting young dogs that are either unvaccinated or under-vaccinated.

Although CPV can be life threatening, this article will focus on pathophysiology and important treatment strategies to reduce morbidity and mortality. This article will also review the use of outpatient protocol compared to in-hospital treatment, including the recent findings from Colorado State University.

Clinical Signs

CPV patients present with non-specific signs of illness including anorexia, lethargy, hypersalivation, vomiting, diarrhea and/ or hematochezia. The lack of intake (anorexia) along with gastrointestinal loss (vomiting and diarrhea) results in dehydration, hypovolemia and, subsequently, shock.

As a result, dogs often present with abnormal perfusion parameters, including abnormal mucous membrane color, prolonged capillary refill time, weak or poor femoral pulses, lethargy, tachycardia and potentially altered mentation. Other examination findings include abdominal pain and potentially secondary signs of illness resulting from vomiting, notably respiratory signs due to concurrent aspiration pneumonia.

bone marrow, as well as consumption of peripheral neutrophils.

Lymphopenia may also be seen and has been demonstrated to be more severe in those that die from CPV. While continued lymphopenia is a poor prognostic indicator, a rebound in lymphocyte count was positively associated with survival. Other CBC abnormalities can include a nonregenerative anemia secondary to gastrointestinal hemorrhage and acute blood loss and thrombocytopenia following systemic inflammation and platelet consumption.

Venous blood gas findings often include metabolic acidosis as a result of hyperlactatemia and poor perfusion. Prerenal azotemia may also be seen, also a result of poor perfusion. Hyponatremia and hypochloremia are also common as a result of severe gastrointestinal loss (diarrhea and vomiting) and lack of intake (anorexia).

Hypoglycemia may also develop as a result of excessive glucose utilization, decreased intake and decreased gluconeogenesis.

Diagnosis

The most common test for diagnosis of CPV is the enzymelinked immunosorbent assay (ELISA) test. The ELISA is a rapid, bed-side, inexpensive test for CPV antigen. The CPV ELISA test detects viral antigen in rectal swabs/feces for all CPV type-2 variants. While polymerase chain reaction (PCR) assays are available, this is not commonly chosen for initial CPV evaluation.

Ancillary diagnostic tests for CPV patients may include a blood smear, complete blood count (CBC), serum biochemistry profile including electrolytes, venous blood gas, coagulation panel and fecal flotation.

As CPV infection results in destruction of hematopoietic progenitor cells, a common CBC finding is leukopenia.

Neutropenia is a result of myeloblast destruction within the

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Blood smear.

Photo courtesy of Dr. Garret Pachtinger

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2. Hypoglycemia Neonates and pediatric patients that present with lack of intake (anorexia) and/or gastrointestinal losses (vomiting, diarrhea) are prone to not only dehydration/hypovolemia but hypoglycemia as well. Intravenous dextrose is recommended for these patients (0.5-1.0 g/kg or 0.5-1.5 ml/kg IV of 50% dextrose, diluted 1:4).

Oral dextrose can be considered if IV or IO access is not available.

Hypoglycemic patients should also receive isotonic crystalloid fluids supplemented with 2.5-5% dextrose as a CRI until they are able to maintain their glucose level without supplementation.

3. Antibiotic Therapy Although CPV itself is not susceptible to antibiotics, antibiotics are generally indicated in parvovirus patients due to the concern for bacterial translocation — due to the damaged villi and diminished gut mucosal barrier from viral damage — along with immunosuppression caused by the virus resulting in leukopenia. Beta lactam antimicrobials are commonly used, as they are generally considered to be safe in pediatric patients. The Colorado State University Outpatient Parvo Protocol (see below) also discusses the use of cefovecin (Convenia©).

4. Gastrointestinal Support Anti-emetics (e.g. maropitant, ondansetron) are commonly used to treat nausea, vomiting and patient discomfort. The author prefers maropitant at a dose of 1 mg/kg IV every 24 hours.

IVF.

Photo courtesy of Dr. Garret Pachtinger

Treatment Treatment of the CPV patient involves fluid therapy, antibiotic therapy, nutritional support, gastrointestinal support and ancillary supportive care.

1. Fluid therapy One of the most common causes of illness as a result of CPV infection is fluid loss from the gastrointestinal tract resulting in dehydration and eventual hypovolemia/hypovolemic shock.

Neonates and pediatric patients have higher fluid requirements; therefore, gastrointestinal losses (vomiting and/or diarrhea), along with lack of intake (anorexia), can quickly result in dehydration and hypovolemia. Intravenous and/or intraosseous routes of fluid administration are recommended routes for fluid therapy. Shock fluid therapy is commonly provided using an isotonic crystalloid, 20-40 ml/kg as a bolus. Following the bolus, patient re-assessment is required to evaluate the need for further fluid resuscitation. Careful attention is also needed for additional supplementation, including potassium and/or dextrose. The use of hypertonic saline and/or synthetic colloids can also be considered for the patient that presents in shock.

24 | FVMA ADVOCATE

5. Analgesia As discussed earlier, abdominal pain is a common finding in CPV patients. While some avoid opioids due the possibility of slowing intestinal transit time, when it comes to dogs with visceral pain, the author recommends using buprenorphine (0.01 - 0.02 mg/kg IV, IM, SQ). NSAIDs and corticosteroids should not be used due to their GI effects.

Finally, the outpatient protocol has gained attention since publication, "Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis" in the Journal of Veterinary Emergency and Critical Care.

Although this study was small (20 in-patient puppies were compared to 20 modified "outpatient" puppies), the study showed an 80% survival in the outpatient group compared to 90% in the in-patient group. While this protocol was not developed to be a substitute for the gold standard of care (hospitalization and administration of fluids/medications intravenously), it proves outpatient care can be considered as an alternative for clients that cannot afford the recommended in-hospital treatment protocol.

In this outpatient protocol study, both groups received initial intravenous fluid and dextrose support, and they were only released for outpatient care once stabilized. Following the initial in-hospital therapy, outpatient treatment included subcutaneous fluids, cefovecin antibiotic therapy and maropitant as an antiemetic. Other considerations in these patients included dextrose and potassium supplementation and nutritional support. While hospitalization may be best for many patients, a

significant number will survive with a carefully planned and implemented outpatient parvo protocol (OPP).

Conclusion

While CPV remains a common disease in young patients, the prognosis for canine parvovirus infection is good with treatment. When financial limitations exist, the clinician can consider the outpatient protocol. While the survival rate (80%) is slightly lower compared to in-patient care (90%), this outpatient protocol can be offered as a reasonable option for clients that cannot afford in-patient care.

References

1. Decaro N, Crescento G, Desario C, et al. Long-term viremia and fecal shedding in pups after modified–live canine parvovirus vaccination.

Vaccine. 2014;32:3850–3853.

2. Desario C, Decaro N, Campolo M, et al. Canine parvovirus infection: which diagnostic test for virus? 2005;126(1–2):179–185.

3. Glickman LT, Domanski LM, Patronek JG, et al. Breed-related risk factors for canine parvovirus enteritis. J Am Vet Med Assoc.

1985;187:589.

4. Goddard A, Leisewitz AL, Chistopher MM, et al. Prognostic usefulness of blood leukocyte changes in canine parvoviral enteritis.

J Vet Intern Med. 2008;22:309–316.

Garret Pachtinger, VMD, DACVECC Dr. Garret Pachtinger is a boardcertified veterinary specialist in emergency critical care and a member of the ACVECC Board of Regents. Dr. Pachtinger graduated from the University of Pennsylvania School of Veterinary Medicine. He then pursued an internship, emergency fellowship and emergency residency at the Ryan Veterinary Hospital at the University of Pennsylvania.

He is currently an associate, internship director and trauma center medical coordinator at the Veterinary Specialty and Emergency Center in Levittown, Pennsylvania. Dr. Pachtinger has been published in numerous veterinary journals, textbooks and peer-reviewed learning tools and is on the editorial board of Today’s Veterinary Practice. Dr. Pachtinger lectures throughout the world on emergency and critical care and is the co-founder of VETgirl, a subscription-based service offering veterinary continuing education (CE).

5. Houston DM, Ribble CS, Head LL. Risk factors associated with parvovirus enteritis in dogs: 283 cases (1982-1991). J Am Vet Med Assoc. 1996;208:542.

6. Lawler DF. Neonatal and pediatric care of the puppy and kitten.

Theriogenol. 2008;70:384-392.

7. Lenberg J, Sullivan L, Boscan P, et al. The effects of maropitant versus ondansetron on the clinical recovery of dogs with parvoviral gastroenteritis. J Vet Intern Med. 2012;26(3):795 (abstract).

8. Li R, Humm KR. Canine parvovirus infection. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine, 2nd ed. Saint Louis, MO: Elsevier-Saunders; 2015:509-513.

9. Macintire DK. Pediatric fluid therapy. Vet Clin North Am Small Anim Pract. 2008;38:621-627.

10. Mantione NL, Otto CM. Characterization of the use of antiemetic agents in dogs with parvoviral enteritis treated at a veterinary teaching hospital: 77 cases. J Am Vet Med Assoc. 2005;227(11):1787–1793.

11. Mohr AJ, Leisewitz AL, Jacobson LS, et al. Effect of early enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis. J Vet Intern Med. 2003;17(6):791–798.

12. Otto CM, Drobatz KJ, Soter C. Endotoxemia and tumor necrosis factor activity in dogs with naturally occurring parvoviral enteritis.

J Vet Intern Med.1997;11:65–70.

13. Preisner K, Sullivan L, Boscan P. Evaluation of an outpatient protocol in the treatment of canine parvoviral gastroenteritis. J Vet Intern Med. 2013;27(3):721 (abstract).

14. Proksch AL, Unterer S, Speck S, et al. Influence of clinical and laboratory variables on faecal antigen ELISA results in dogs with canine parvovirus infection. Vet J. 2015;204:304–308.

15. Savigny MR, Macintire DG. Use of oseltamivir in the treatment of canine parvoviral enteritis. J Vet Emerg Crit Care. 2008;20(1):132–142.

16. Venn EC, Preisner K, Boscan PL, et al. Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis. J Vet Emerg Crit Care.2017;27(1):52-65.

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PRACTICE GOT A QUESTION? THE FVMA CAN HELP. One of the benefits of an FVMA membership is our Helpline (800.992.3862), which is available to members Monday through Friday from 8 a.m.-6 p.m. Our Helpline also provides insight to the FVMA staff of the challenges and concerns of our members.

In this feature, we will highlight topics from the questions we received in preceding weeks as a part of an effort to keep our members up to date on current concerns, as well as regulatory and legislative changes.

QUESTION: I wanted to know if there are any Florida regulations in place that would prevent an establishment from performing non-anesthetic dentals without a veterinarian present? I am under the impression that anesthetic procedures must be done with a veterinarian present, but what about non-anesthetic procedures like dentals? Can they be performed without a veterinarian on staff? There are several pet boarding facilities that are offering non-anesthetic dental cleanings even though they do not have a veterinarian present, and it's a technician that performs them. I would just like some clarification on this.

A: As is often the case with similar bills, this is an amendment to Chapter 456 in the Florida statues and is applicable to health care practitioners as defined in Chapter 456. That chapter defines health care practitioners as:

“Health care practitioner” means any person licensed under chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I, part II, part III, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part II or part III of chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491.

A: For starters, any dental procedure on an animal, with the

Veterinarians are licensed under Chapter 474 in the Florida statues and, therefore, are not included.

QUESTION: Can I attend the New York Vet Conference to fulfill my CE requirements in Florida?

QUESTION: We are a racetrack practice in Florida and are starting to receive these agreements to sign for use of compounded drugs.

Veterinarians are curious about the ramifications of signing these agreements. We are interested in receiving an opinion from the FVMA regarding agreements such as these. What additional liability burden does this place on the practitioner? Does “compounded nonsterile medications for office use" imply that injectable medications are non-sterile?

exception of manually floating teeth on horses, is the practice of veterinary medicine. A technician can perform certain tasks under general supervision, and non-anesthetic dental cleaning can be performed without the veterinarian present but that does not mean a veterinarian is not required. Boarding facilities that have technicians perform dental cleanings without any veterinary supervision (offpremises) are engaging in unlicensed activity.

A: Yes. According to the below statue, approved courses are deemed scientific if continuing education courses are provided by:

61G18-16.003 Continuing Education Standards.

(2) (a) National, State and International veterinary association meetings and Board meetings;

QUESTION: There is a lot of confusion about HB 831 and whether it applies to veterinarians prescribing drugs that are controlled by the DEA. I am hoping that you can give me some guidance on this topic. E-signatures are not something I have in my software currently, and I would need them if this bill involves veterinarians.

This will certainly cause an increase in cost to get these medicines to our patients.

26 | FVMA ADVOCATE

A: The Florida Board of Pharmacy Rule is below. The agreement is part of the rule, and it incorporates the rule requirements. The only restriction that is not required is the one about dispensing the compounded medication to clients. Under (f)6., the Board recognizes that if the drug is provided to a veterinarian, the “Not for Resale” label is not required.

(3) Office use compounding, “Office use” means the provision and administration of a compounded drug to a patient by a practitioner in the practitioner’s office or by the practitioner in a health care facility or treatment setting, including a hospital, ambulatory surgical center, or pharmacy. A pharmacist may dispense and deliver a quantity of a compounded drug to a practitioner for office use by the practitioner in accordance with this section provided: (a) The quantity of compounded drug does not exceed the amount a practitioner anticipates may be used in the practitioner’s office before the expiration date of the drug; (b) The quantity of compounded drug is reasonable considering

the intended use of the compounded drug and the nature of the practitioner’s practice; (c) The quantity of compounded drug for any practitioner and all practitioners as a whole, is not greater than an amount the pharmacy is capable of compounding in compliance with pharmaceutical standards for identity, strength, quality, and purity of the compounded drug that are consistent with United States Pharmacopoeia guidelines and accreditation practices. (d) The pharmacy and the practitioner enter into a written agreement.

The agreement shall specifically provide: 1. That the compounded drug may only be administered to the patient and may not be dispensed to the patient or sold to any other person or entity, 2. That the practitioner shall include on the patient’s chart, medication order, or medication administration record the lot number and the beyond-use-date of any compounded drug administered to the patient that was provided by the pharmacy, 3. That the practitioner will provide notification to the patient for the reporting of any adverse reaction or complaint in order to facilitate any recall of batches of compounded drugs. (e) The pharmacy shall maintain readily retrievable records of all compounded drugs ordered by practitioners for office use. The records must be maintained for a minimum of four (4) years and shall include: 1. The name, address and phone number of the practitioner ordering the compounded drug for office use and the date of the order, 2. The name, strength, and quantity of the compounded drug provided, including the number of containers and quantity in each, 3. The date the drug was compounded, 4. The date the compounded drug was provided to the practitioner, 5. The lot number and beyond use date. (f) The pharmacy shall affix a label to any compounded drug that is provided for office use. The label shall include: 1. The name, address, and phone number of the compounding pharmacy, 2. The name and strength of the preparation of a list of active ingredients and strengths, 3. The pharmacy’s lot number and beyond-use-date, 4. The quantity or amount in the container, 5. The appropriate ancillary instructions such as storage instructions, cautionary statements, or hazardous drug warning labels were appropriate; and, 6. The statement “For Institutional or Office Use Only – Not for Resale,” or if the drug is provided to a veterinarian the statement “Compounded Drug.” (g) In the case of compounded products intended for human use, the pharmacy must be in full compliance with 21 U.S.C. §353b, including being registered as an Outsourcing Facility. 21 U.S.C. §353b (eff. Nov. 27, 2013) is hereby adopted and incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04180.

Also, Florida law specifically recognizes that veterinarians may dispense compounded medications. See 465.0276(5): 465.0276 Dispensing practitioner.— (5) This chapter and the rules adopted thereunder do not prohibit a veterinarian licensed under chapter 474 from administering a compounded drug to a patient, as defined in s. 474.202, or dispensing a compounded drug to the patient’s owner or caretaker. This subsection does not affect the regulation of the practice of pharmacy as set forth in this chapter.

Having stated all the above, it is the right of the pharmacy to require that the compounded drugs they provide to veterinarians will not be resold/dispensed.

QUESTION: I received my Florida DVM license just a few weeks ago, and the expiration date is May 2020. Will I be required to complete all 30 hours of CE requirements or a pro-rated portion?

A: The rule on continuing education requirements states: A licensed

veterinarian shall not be required to complete a continuing education requirement prior to the first renewal of his license, but it shall be required prior to any subsequent renewal.

That being said, you do not need CE for your upcoming renewal. You will be required to do 30 hours, including one hour in the area of dispensing legend drugs and two hours in the area of laws and rules governing the practice of veterinary medicine in the next biennium (from June 1, 2020 to May 31, 2022).

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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.

THE FVMA |

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CLASSIFIED ADVERTISEMENTS VETERINARIANS WANTED

VETERINARIAN WANTED – KEY LARGO, FL: The Island Hammock Pet Hospital is looking for the right candidate with several years of experience to help us continue to grow and achieve our goals of providing exemplary medicine to our patients and outstanding service to our clients.

We are a new, fast growing, three doctor companion animal practice located in Key Largo, Florida. We offer a strong compensation package, an experienced staff and a rewarding work environment. We operate a new, AAHA accredited, state of the art facility and utilize efficient business practices. You can learn more about us at www.IHPH.net.

The fabulous Florida Keys offers some of the best fishing and SCUBA diving available in North America. Island life is a laid back, semi-rural lifestyle. All of the advantages of a large metropolitan area are within a 45 minute drive. If you love the water and sun, the Florida Keys is a great place to live.

To learn more about the position, please send your resume to careers@IHPH.net. (6/19; ID#10524) VETERINARIAN WANTED – WINTER HAVEN, FL: We are seeking an experienced Associate Veterinarian to join our team at Orchid Springs Animal Hospital. We are a progressive, professional 4-doctor & AAHA certified hospital. We are an integrated practice with a diverse caseload including wellness care, general medicine, soft tissue surgery, dentistry and acupuncture. Our mission is to strengthen the human and animal bond through excellent veterinary care in a compassionate and friendly atmosphere.

An ideal candidate would be passionate about Veterinary Medicine, have a strong surgical background, knowledgeable about exotic-pocket pets, have a strong work ethic, and good communication skills. Doctors are supported with modern equipment such as the latest in-house lab and diagnostics, surgical laser, digital and dental radiology, therapy laser, and ultrasound.

Our culture is friendly and team-oriented, we promote best practices and up-to-date technology and techniques. We offer flexible schedules for our Monday-Saturday work week along with highly competitive pay. There is ample opportunity to develop special skills and interests.

At least three years of experience is desired. Benefits include national, state and local association dues, continuing education, professional liability insurance, and full benefits – medical, dental, vision, life, paid holidays and PTO. Salary is at the top range of competitiveness and commensurate with experience.

Orchid Springs Animal Hospital, 615 Overlook Dr., Winter Haven, Fl 33884 (863) 324-6964; www.osahvets.com (6/19; ID#27588) VETERINARIAN WANTED – GAINESVILLE, FL AND OCALA, FL: Country Critters is a full-service hospital located inside select Rural King stores. We expanding companion animal practices seeking a full time associate. We have great benefits and pay $100,000+ for experienced candidates. Bonus potential. Email jstewart@ruralking.com.(6/19; ID#37347) VETERINARIAN WANTED – TALLAHASSEE, FL: Full-time small animal associate veterinarian is needed at Novey Animal Hospital. We are looking for a veterinarian to join our team that enjoys practicing high-quality medicine and surgery in a client-centered, compassionate and collaborative manner. We are located in Tallahassee, Florida, home of the state capitol, FSU, FAMU, and are only a short drive to the beach. Tallahassee is ranked in the top 100 best places to live in America and one of the best places to raise a family.

We are a well-established hospital, with great clientele and a well-trained staff. We are equipped with digital dental radiography, digital radiography, ultrasound, laser, and more, with a specialty hospital and multiple emergency hospitals within minutes.

Our associates enjoy great benefits, including a 4.5-day work week, no emergency on-call, health insurance, 401(k) match, and more! Recent and new graduates are welcome; mentorship will be provided and collaboration amongst our doctors is highly valued and expected. Please contact: Larry Novey, larrynovey@hotmail.com or (850) 508-2171. (6/19; ID#12890) VETERINARIAN WANTED - CENTRAL FL: $100,000 for 20-hours a week.

Call 407-614-7458. (6/19; ID#28095) VETERINARIAN WANTED – DAVIE, FL: DPC is searching for a Chief of Staff Veterinarian. DPC is a full-service veterinary hospital in Davie, Florida.

Since our establishment in 2001, we have designated the care, diagnosis, and treatment of our clients' pets as our primary concern. We are dedicated to providing the highest level of veterinary care for the community.

Our mission is to provide comprehensive, high-quality veterinary care with an emphasis on exceptional client service and patient care. We offer some of the most current veterinary treatments such as digital radiography, dental

28 | FVMA ADVOCATE

radiography, ultrasound, laser therapy, acupuncture and rehabilitation. This, along with our core values of we care and it shows, we always do the right thing, we say yes I can, and we learn and grow, has earned us a dedicated client base and status as a leader in veterinary care in the Hollywood/Fort Lauderdale area.

We are seeking an experienced and dedicated DVM for our Chief of Staff Veterinarian. This individual will advocate for pets and their quality of life and build a long-term relationship with clients. We offer top pay and an excellent benefits package. Please email nancylcassis@gmail.com or call Nancy at 954-989-9879 ext 5. (6/19; ID#47476) VETERINARIAN WANTED – MIAMI BEACH, FL: Full-time, part-time veterinarian wanted. Experience required. Affordable preventative medical care, routine surgeries, urgent care offered. No ER. Canine, feline only. Bilingual helpful. $35.00-$75.00 p/hr based on experience, plus quarterly bonuses.

Fully staffed. Miami Beach area. Contact Danielle Garofalo at The Pet Vet at Normandy Isle 305-979-7578 or dgarofalo@petvetnisle.com. (6/19; ID#27936)

CVT WANTED

CVT WANTED - FORT LAUDERDALE, FL: This is an unusual opportunity to help create and teach a new Veterinary Assistant program that Merryfield School of Pet Grooming will be offering. We will be changing the name of our school to reflect the inclusion of this offering. We will be following the NAVTA guidelines and will support students that want to take their Certification Exam.

If you are bi-lingual that would be a plus, but not a requirement. Please call Gregg Docktor, Director 954-771-4030. (6/19; ID #3617)

RELIEF VETERINARIAN WANTED

ASSOCIATE WANTED – COLONY PLAZA ANIMAL HOSPITAL: Looking "Got to get away? "VetRxRelief , 37 years experience small animal Veterinarian.

Please call 321-508-3879 or Vetgator@gmail.com. (6/19; ID #9238)

PRACTICES FOR SALE OR LEASE

PRACTICE FOR SALE – TAMPA, FL: Small animal practice for sale in Tampa. Established since 1960. 2018 gross $700,000. Owner retiring. Call Dr. F.R. Tellekamp- 817-777-6878. (6/19; ID #4672) SINGLE DOCTOR PRACTICE FOR SALE – OKEECHOBEE, FL: Excellent Growth Potential for large and small animal. Buy with or without real estate.

Small town Lifestyle...Great place to raise family and enjoy Lake Okeechobee! www.mimsveterinaryhospital.com 863-763-9200. (6/19; ID #1792) RELIABLE AND AFFORDABLE BOOKKEEPING – CENTRAL FLORIDA: DO YOU NEED RELIABLE AND AFFORDABLE BOOKKEEPING for your practice? ACCOUNTING Simplified is a full-service, outsourced bookkeeping firm, located in Central Florida. We provide the depth of a fully staffed accounting department at a reasonable fixed cost without the overhead expense of an in-house accounting department. Based on information gathered during the initial consultation, we will customize our services to best suit your needs. Our fees are based on the volume of transactions and the frequency with which you want the information updated (weekly, semi-monthly, monthly). We will determine a monthly fixed price, which will be steady, predictable and easy to budget for your practice. We offer: • QuickBooks • Bank account and Credit Card reconciliation services • Payroll processing • Sales Tax Submissions • Accounts Receivable and Accounts Payable • Financial reporting (profit and loss by month and with previous year comparison, balance sheets, AP/AR aging details) No more second guessing what your CPA and the IRS expect. ACCOUNTING Simplified is your accounting department. Call Denise at 407-493-9947 or email denise@accountingsimplified.com for more information. (6/19; ID #47433) CSR AND INDUSTRY SALES WANTED – ST. AUGUSTINE, FL: Veterinary Orthopedic Implants is the leader in our industry offering selection, value, education, and a customer-focused approach! We are a growing company located in St. Augustine, FL with an AWESOME company culture. We are currently looking for industry professionals for both CSR roles AND for Industry Sales professionals to help us continue our rapid growth pattern.

Please apply directly at www.vetimplants.com/careers-at-voi or email HR at Kristine.thornton@vetimplants.com. (6/19; ID #47476) PRACTICE FOR SALE – MELBOURNE, FL: Turn Key, fully equipped hospital , Space Coast, close to beach, marina, and shopping. Equipment also for sale separately. Call 321-508-3879 or VetGator@gmail.com. (6/19; ID #2787)

Since 1997 ∙ Preserving practice identities ∙ Helping practices grow

& Georgia ∙ Respecting Florida clinical independence

Practices for Sale

Florida & Georgia Practices for Sale

∙ Adding career paths & benefits

Under Contract! ∙ EarningFL: a caring reputation

Jacksonville: Solo dr, SA prx. Gross $518K+. No after-hours ER. RE Included. (FL43J)

FL: Under Contract! Jacksonville: Solo dr, SA prx. Gross $518K+. No after-hours ER. RE Included. (FL43J)

GA: Hinesville: Solo dr, SA prx. $930K+ Gross.

Considering practice $196K personal income to new owner. (GA34H)

GA: Hinesville: Solo dr, SA prx. $930K+ Gross. $196K personal income to new owner. (GA34H)

GA: South Central GA: $959K+ gross, up 5% a place to build your in 2019, 1.5 doctor practice.

Nice facility & career? equipment. (GA14F)

GA: South Central GA: $959K+ gross, up 5% in 2019, 1.5 doctor practice. Nice facility & equipment. (GA14F)

FL: SOLD! South Central FL: Congratulations Over 340 locations to Dr. Jeff Saunders on the sale of his practice, Saunders Veterinary Services.

(FL28A) in 31 states -

FL: SOLD! South Central FL: Congratulations to Dr. Jeff Saunders on the sale of his practice, Saunders Veterinary Services. (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, www.VetCor.com and South Carolina Real Estate Broker

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

FloridaFlorida & Georgia Practices for Sale Practice Listings!

Sales - Valuations Representation - Certified Valuation Analyst Florida &- Buyers Georgia Practices for Sale

succession? Looking for

acquisitions: acq@vetcor.com jobs: careers@vetcor.com

Central Florida– North of Tampa– Well established, Solo Dr., $860K gross in 2018. In-house lab, digital x-ray, dental x-ray, FL:ft.Under Contract!

Solo dr, SA 4400 sq. free standing hospitalJacksonville: w/ 3 exam rooms, Prx and RE available a turnkey operation.

Price just reduced. prx.in Gross $518K+.

No after-hours ER. RE

Included.

(FL43J) SE Coastal Fl.– Solo Dr. Practice grossing $822K, 6100 sq ft office and boarding space. Well equipped with experienced staff.

GA: Hinesville: Solo dr, SA prx. $930K+ Gross.

Located in an upscale beach community. $196K personal income to new owner. (GA34H)

Greater Orlando area– Solo Dr. has worked only part time.

Nice 2700 freestanding a new major 6 lane.

GA:sq.ft.

South Centraloffice GA:on $959K+ gross, up 5% Great opportunity for Start-up/Jump-Start. Priced to sell.

in 2019, 1.5 doctor practice. Nice facility & New–equipment.

S.E. Coast– (GA14F) Just minutes from the beach….Solo Dr.

grossing ~$630K. Lease space with 4 exam rooms, very well equipped, theSouth community for 40 FL: years.

Approximately FL: served SOLD! Central Congratulations $160K in after debt income...priced to sell.

to Dr. Jeff Saunders on the sale of his practice, Saunders Veterinary Services. (FL28A) Are Corporate Groups contacting you about buying your Practice?

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

1610 Frederica Road, Saint Simons Island, GA 31522

ContactToll Dr. Richard Alker for further practice information.

Free: (800) 333-1984 | www.simmonsinc.com Email: southeast@simmonsinc.com 850.814.9962 or Richard@tpsgsales.com

Licensed in Florida, Georgia, North Carolina, Showcase of Central Florida, Broker and Properties South Carolina Real Estate Broker

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FL: Under Contract! Jacksonville: Solo dr, SA prx.

Gross $518K+.

NoSolo, after-hours ER. practice RE PALM BEACH COUNTY: small animal Included.

(FL43J) on the southeast coast! +$500k gross, +$111k ADI can be expected. Appx. 1,150 sq. ft. leased facility.

GA: dr, SA affluent prx. $930K+ Gross.

GreatHinesville: opportunity Solo in a vibrant, community! $196K FL95 personal income to new owner. (GA34H) GA: South CentralFamily GA: $959K+ gross, up 5% VOLUSIA COUNTY: owned, small animal in 2019, with 1.5 doctor practice.

Nice+$671k facilitygross & / practice legacy to build upon! +$204k ADI (GA14F) in most recent year. Appx. 3,368 sq. ft. equipment. leased facility. Room to grow! FL96

FL: SOLD! South Central FL: Congratulations LEON COUNTY: Long-established, to Dr. Jeff Saunders on the sale welcoming of his practice, practice with growth potential! +$700k gross / Saunders Veterinary Services.

(FL28A)

+$129k ADI in most recent year. Appx. 1,978 sq. ft. facility with RE. Build your own legacy! FL97 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 | 800.636.4740 | info@psbroker.com psbroker.com

THE FVMA |

@FLORIDAVMA |

@FLORIDA_VMA | 29

THANK YOU TO ALL OUR

2020 LEGISLATIVE ACTION DAYS DELEGATES! WE APPRECIATE ALL THOSE WHO PARTICIPATED IN ADVOCATING ON BEHALF OF THE FVMA AND VETERINARY PROFESSION AT LAD 2020 IN TALLAHASSEE, FLORIDA!

Rep. Josie Tomkow (second from right) with Drs. Julia Jones Reynolds, Todd Fulton and Marc Presnell (left to right).

A group shot of the LAD 2020 delegates at the state Capitol in Tallahassee, Florida.

Photo courtesy of Dr. Julia Jones Reynolds

Photo courtesy of Ann Wade

Rep. Wengay “Newt” Newton of St. Petersburg, Florida (third from right) with Drs. Rachel Klemawesch, Donald Howell, Donald Morgan, Brooke Certa and Daniel Jones (left to right).

UFCVM students ready to meet with legislators at the state Capitol.

Photo courtesy of Michelle Grimsley

Photo courtesy of Ann Wade

Best Friends Forever Pet Moving Solutions Worldwide • Nationwide airanimal.com

Photo credit: www.123rf.com/profile_sam74100

Our Listings Are PRACTICE SALES VALUATIONS BUYER REPRESENTATION ASSOCIATE BUY-INS

WE WELCOMED SIX NEW PSA CLIENTS INTO THE MILLIONAIRE'S CLUB! GA

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Florida Veterinary Medical Association 7207 Monetary Drive Orlando, FL 32809

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