Newsletter
As we entered this work week, our hearts were heavy and saddened after the recent senseless killings of George Floyd, Ahmaud Arbery, and Breonna Taylor. These events follow a long history of racial injustice and discrimination in our country. Many of us are struggling to process the anger and grief produced by these tragedies. As President of BCVMA, I want our organization to be about more than continuing education. I want Broward County veterinarians to recognize the injustices that occur on a daily basis and have a platform for open discussion and dialogue that incorporates personal reflection, self-care, and empathy. We have a responsibility to embrace diversity, equity, and inclusion and stand up against racism and discrimination in all of its forms. We serve as role models for our new veterinary graduates and need to demonstrate that we are trying to make a difference in the veterinary community. There is so much more that we can do as individuals, as an organization, and as a community. To this end, I share the recent statement from the American Veterinary Medical Association affirming these words and our duty as veterinarians to “reject all forms of prejudice and discrimination.” Stephanie Jones, DVM President
From THE PRESIDENT'S DESK June 2020
At this critical moment in history, the American Veterinary Medical Association emphasizes its commitment to diversity, inclusion and tolerance, and calls upon all institutions, public and private, to actively commit to anti-racism, justice, and equitable treatment of all people. In the simple words of our AVMA Code of Ethics, we "reject all forms of prejudice and discrimination." On behalf of the AVMA and its members, we reaffirm our commitment to doing all that we can to eliminate racism, sexism, and any other barriers that would deny any individual of their right to health, safety, justice and economic opportunity. The AVMA stands with the black community — now more than ever.
June 2020
Vet Directory Please visit our website Veterinary Directory page to view our compendium of local resources. If you'd like to add your information to this list, please email Laura at Lcarran@gmail.com.
Board of Directors 2020 President Stephanie Jones, DVM drstefni@gmail.com Immediate Past President Lisa Feinstein, DVM lisafeinstein@bellsouth.net Secretary Dylan Buss, DVM dylangbuss@gmail.com Treasurer Claudia Valderrama, DVM claudia67v@aol.com Education Chair Lisa Feinstein, DVM lisafeinstein@bellsouth.net Social Chair Jason Horgan, DVM jason081977@aol.com Newsletter Chair Armando Villamil, DVM drv@petcancergroup.com
Membership Information Enjoy the camaraderie and top-notch continuing education offered by the BCVMA! We offer five great CE meetings per year, a newsletter, and the best Holiday Party in South Florida! Membership is $130 yearly. You can join or renew by visiting our website: www.BrowardCountyVMA.com or e-mail bcvma@mail.com for more information. We look forward to seeing you!
In person continuing education meetings are on hold for now. We hope to restart in person, dinner meetings at the Fort Lauderdale Country Club by August, but we have to wait and see for the Country Club and the county to give guidelines on meetings. In the mean time, there are plenty of online CE options that are free for the most part. Visit the website and get on email list for Vetgirl, Pet Poison Control, Idexx, Zoetis, Clinicians Brief, Assisi Vet, USDA Vet CE, Blue Pearl, AVMA, Purina Institute, and Biogal labs. University of Florida Florida Laws and Rules and Pharmacy June Webinar : Free in honor of Rdvm Day Register Online Southeast Veterinary Neurology Webinar for Bcvma A Pain in the Neck! A Review of Cervical IVDD | SEVN Webinar Series Presented by: Montana DiVita, DVM Wednesday June 17 at 7 pm Register Online Cardiology lecture, Tacy Rupp DVM, MS, DACVIM Wednesday August 19 at 7 pm (expected to be in person at Fort Lauderdale Country Club). Ophthalmology lecture, Dr. Dylan Buss DVM, MS, DACVO Wednesday October 14 at 7 pm (expected to be in person at Fort Lauderdale Country Club). Nutramax Lecture Wednesday November 4 at 7 pm (expected to be in person at Fort Lauderdale Country Club).
Upcoming Continuing Education
2020 State of Florida DBPR Veterinary Board Meetings The Board of Veterinary Medicine meets throughout the year at different locations throughout the state. Attending any of these meetings will earn you up to five CE law credits and will teach you what really transpires in Disciplinary Procedures that the Board considers. You will benefit by learning how to abide by state DBPR regulations and how to avoid being disciplined because of a violation. Friday, June 19, 2020 at 9:00 am Meeting will be held as a teleconference with disciplinary proceeding postponed until July. Please contact Linda Tinsley with any questions: linda.tinsley@myfloridalicense.com
UF Veterinary Hospitals 2020 RDVM Appreciation Day It’s time for our annual Referring Veterinarian Appreciation Day! New challenges come with new opportunities. This year, we are offering RDVM Day in a virtual format. The most sought-after session every year is Florida Rules and Laws and Pharmacy Dispensing Rules. We are happy to present the entire 3-hour course at no charge, available for you to attend virtually during the month of June. All you have to do is register here. We remain grateful for your support of our mission of veterinary education, whether it is within hospital walls or beyond. You are an important part of the veterinary care team as well as our most important client. While we are very sad not to see you in person, we hope that the virtual format will allow even more of you to take advantage of this opportunity. We hope to see you all in Gainesville next year if not before. Finally, we are pleased to recognize our sponsors. Their continued support allows us to present this course free of charge. Sincerely, Chris Sanchez, DVM, PhD, DACVIM Interim Associate Dean for Clinical Services
Free Florida Rules and Laws and Pharmacy Dispensing Rules CE
Common Procedures & Recent Advances in Minimally Invasive Surgery Barry E. Brower, DVM Diplomate, American College of Veterinary Surgeons- Small Animal Advanced Veterinary Care Center
Epidural Corticosteroid Injection for Lumbosacral Syndrome: a Potential Alternative to Surgery David A. Geiger, DVM Geiger Veterinary Neurology dgeigerdvm@gmail.com
Lumbosacral syndrome (LSS) is a common cause of pain and neurological dysfunction arising from the level of the L7-S1 “motion segment” - that is, the vertebrae, intervertebral disk joining them, articular processes forming synovial joints, and ligaments which provide additional support. All of these tissues play potential roles in this condition, which is also referred to as lumbosacral stenosis, cauda equine syndrome, and lumbosacral degenerative stenosis. The term lumbosacral syndrome is favored as it acknowledges that multiple individual components often combine to cause the symptoms. Components include protrusion or extrusion of the intervertebral disk, degenerative changes and overgrowth of the articular processes and synovial tissues, thickening and mineralization of ligaments, and instability. Instability, defined as excessive movement of the vertebrae beyond their normal range of motion, results in dynamic compression of either the cauda equina within the vertebral canal, the nerves exiting the intervertebral foramina, or both. Dynamic compression of neural tissues is thought to be more damaging than static compression, and can be more difficult to identify as it requires diagnostic imaging in multiple positions. Static compression alone (usually caused by disk protrusion) is often asymptomatic, even when very pronounced. Mild forms of LSS cause intermittent pain in the lower back, often worse after exercise and often most severe when jumping, climbing stairs, or posturing to defecate. Nerve root pain can cause weight-shifting from side to side or transient toe-touching lameness. Pain can be elicited through direct dorsal pressure, elevation of the tailhead, compression of the ileal wings together medially, and extension/lordosis. This author finds lumbosacral extension to be the most sensitive test for lumbosacral pain, performed by lifting the hindquarters upwards slightly with a hand under the pubis, while pushing downwards with the other hand on the dorsal caudal lumbar region. More severe forms of LSS cause neurological dysfunction, including nerve weakness and neurogenic muscle atrophy. Sciatic nerve dysfunction (resulting in plantigrade stance, impaired tarsal flexion, and/or scuffing of the toes) and tail weakness, especially when posturing to urinate or defecate, are commonly observed. In general, urinary or fecal incontinence indicate the most severe form of this condition, and warrant prompt treatment intervention before they become permanent (this can occur within 2 weeks after onset of incontinence). Neuropathic pain is another potentially severe or catastrophic component, as occasionally affected dogs will self-mutilate to the extent of chewing off toes or feet. LSS can affect any dog and also cats, but is most common in middle-aged large breed dogs, and especially common in working dogs including Shepherd breeds. When working dogs develop these symptoms, effective treatment is critical to preserve working ability and avoid premature retirement. First-line treatment option for mild LSS (symptoms limited to pain) is usually medical therapy, which traditionally includes analgesics and/or antiinflammatory drugs administered orally. Nonsteroidal antiinflammatory drugs, corticosteroids, gabapentin, amantadine, tramadol, acetaminophen, and opiates are all commonly used, often in combination.
Epidural Corticosteroid Injection for Lumbosacral Syndrome: a Potential Alternative to Surgery David A. Geiger, DVM Geiger Veterinary Neurology dgeigerdvm@gmail.com dgeigerdvm@gmail.com
Medical therapy is usually combined with courses of reduced activity or strict rest, and ancillary therapies including rehabilitation therapy, acupuncture, cold laser therapy, etc. are also used. While dogs with the most mild symptoms occasionally experience lasting relief with short courses of these therapies, most dogs experience symptom recurrence when treatments are stopped. Medication side effects and diminishing symptom relief over time also limit long-term effectiveness. Surgery is usually considered for dogs who fail medical treatment with incomplete or only transient relief of pain, or for dogs with neurological dysfunction. Reported success rates range from 70-95%. Numerous surgical techniques exist to address heterogenous components of this syndrome, but established criteria to guide procedure choice are lacking. Advances in understanding of the pathophysiology of lower back pain in humans, and in particular lumbar radiculopathy and sciatic pain, led to recognition of chronic nerve inflammation as an important component of human pathology. Nerve compression alone is not thought to frequently cause symptoms without concurrent inflammatory changes. This led to development of various targeted antiinflammatory therapies for treatment in humans, beginning with local injection of corticosteroids at the site of nerve inflammation. This is commonly performed via epidural, foraminal, and paravertebral injection to target the site of nerve pain and inflammation. Although these treatments have been routinely used effectively in human medicine since the 1990s, equivalent treatments have not become widely accepted in veterinary medicine. A 2009 investigation by Janssens into clinical efficacy of epidural corticosteroid injection for lumbosacral syndrome in dogs suggests a high chance of extended or permanent relief of pain from LSS. This study performed fluoroscopically guided translaminar injection of methylprednisolone acetate (Depo-Medrol® injection, 1 mg/kg, 40mg/mL) into the epidural space between L7-S1 in 38 dogs with LSS symptoms limited to pain who had previously failed conservative medical management. Injections were repeated as needed when pain was judged by owners to have recurred. Results indicated that 50% of dogs exhibited immediate mild side effects including polyuria/polydipsia, transient worsening of pain, and/or persistent drowsiness following sedation. All side effects resolved within 5 days after injection. All dogs were reported to clinically improve after each injection.Median time to recurrence of pain after the first injection was 11 days. For three subsequent injections, median duration of efficacy appeared to sequentially increase to 38 days, 135 days and 159 days. Overall, 79% of dogs experienced reduction in pain and 53% were judged by their owners to be pain-free at the end of the study period. 25% returned for more than 3 injections. Overall efficacy of this treatment was found to be comparable, though somewhat inferior, to surgery. Major advantages of this treatment include near-absence of typical side effects of systemic corticosteroid administration, prolonged pain relief without need for daily medication administration, low complication risk, and low cost. While systemic absorption of epidurally administered methylprednisolone acetate is thought to be low, It is unknown whether concurrent administration of NSAIDS is safe.
The most significant drawbacks to the Janssens study are lack of controls, assessments performed by the owners and not by a veterinarian, and unvalidated questionnaire. Nonetheless, the criteria for successful response to therapy are comparable to those assessing conservative treatment with oral analgesics. Lumbosacral epidural injection is not technically difficult and can be performed blindly or with fluoroscopic, CT, ultrasound, or radiograph guidance. Complications are rare but include epidural or subarachnoid/intrathecal hemorrhage, infection, and lumbosacral intervertebral disk extrusion. In 2015, Liotta demonstrated the feasibility of CT-guided percutaneous injection of methylprednisolone acetate into the L7-S1 articular facet joints, epidural space via translaminar puncture, and epidural space via intervertebral foramen in healthy Beagles. Serious complications were not encountered, though mild and transient regional reflex depression was observed in some dogs. This opens up additional potential administration routes. In human medicine, targeted anti-inflammatory therapy with compounds such as⍺-TNF is also effective, and these therapies may be next on the horizon for investigation in dogs. For now, epidural methylprednisolone acetate injection is considered a useful and minimally invasive trial therapy for dogs who have failed traditional medical management before considering surgery. At Coral Springs Animal Hospital, we perform this procedure on an outpatient basis for dogs meeting the above criteria, including law enforcement working dogs and pets. Dogs are only considered candidates following clinical and MRI confirmation of uncomplicated LSS as the cause of the symptoms. This reduces procedural risk by ensuring compatible anatomy without complicating factors. In dogs who fail this therapy or who exhibit more serious symptoms, surgery is recommended. References 1.Janssens L, Beosier Y, Daems R. Lumbosacral degenerative stenosis in the dog. The results of epidural infiltration with methylprednisolone acetate: a retrospective study. Vet Comp Orthop Traumatol. 2009;22(6):486‐491. doi:10.3415/VCOT-08-07-0055 2.Liotta AP, Girod M, Peeters D,et. al. Clinical effects of computed tomography-guided lumbosacral facet joint, transforaminal epidural, and translaminar epidural injections of methylprednisolone acetate in healthy dogs. Am J Vet Res. 2016;77(10):1132‐1139. doi:10.2460/ajvr.77.10.1132 Dr. Geiger received his BS from M.I.T. in 1999, DVM from Cornell University in 2003, and completed a residency in veterinary neurology and neurosurgery at the Virginia-Maryland Regional College of Veterinary Medicine in 2009. He passed the ACVIM Neurology certifying exam in 2010, with board certification awaiting Master's thesis defense. He previously completed a rotating internship in small animal medicine and surgery at the Veterinary Specialty Hospital of San Diego, and completed additional training in neuroimaging and neurosurgery at Canada West Veterinary Specialists. Dr. Geiger established the first neurology/neurosurgery service in San Francisco, and developed and operated full-time neurology/neurosurgery departments at several SF Bay Area area hospitals between 2009-2017. He also helped to launch the only dedicated veterinary neurology clinic in New Mexico. Since 2017, Dr. Geiger has offered locum and part-time clinical and consulting services to various multispecialty hospitals across the United States. He currently practices at Coral Springs Animal Hospital with appointments available every other week (954-753-1800). Please feel free to reach out anytime with questions about referral or non-referral cases.
Latest News From Broward County Animal Care & Adoption
ANIMAL CARE CONTINUES TO MODIFY SERVICES Broward County Animal Care continues to remain close to the public. Veterinary Clinics are asked to refer their clients to the Animal Care website at www.broward.org/animal for information about the shelter’s programs and services. Questions can be directed to animalcare@broward.org. Residents are able to adopt or foster a pet by selecting a dog or cat at the Animal Care website and apply online. Customer Service Representatives will contact applicants to complete the process and schedule a time for pet pickup. For other services residents are asked to: •Purchase the pet license tag through your office. If your Clinic does not sell the tag, please direct pet owners to the County’s website at www.broward.org/animal. A copy of a recent Rabies Certificate must be faxed or e-mailed to Animal Care offices. Online purchase instructions are explained on the website. •Delay pet surrenders. Residents are asked to delay surrendering their pet to Animal Care. Walk-in owner surrenders have been suspended. Those who wish to turn in their own pet will be by appointment only. •Continue care of Foster Pets. Foster Parents who are caring for a foster cat or dog, are asked to continue to care for the pet until further notice. Foster care check-ups will be rescheduled to a later date. In the event of an emergency, Foster Parents should call the special phone number that was issued to them. •Suspend the trapping of feral/community cats. Broward County Animal Care will suspend the intake of any trapped feral community cats until further notice. Only injured, sick or abused cats will be accepted. Trappers are asked not to trap any cats with the intent of bringing them to the Animal Care Adoption Center. Trapped healthy cats should be released where they were trapped. •Limit Animal Care Calls for Assistance. Until further notice, Animal Care Officers will respond only to calls that are considered high priority/emergency situations. Such calls include law enforcement assistance, injured or sick stray dogs and cats, animal cruelty and neglect complaints, bites, and dangerous/aggressive dogs. •Take care of lost/stray pets. Residents who have found a friendly stray or lost healthy dog or cat, are asked to care for it until Animal Care resumes normal operations. Food and pet supplies will be provided. The pet should be reported to foundpets@broward.org. Residents who are willing to care for the pet, will be notified if the pet’s owner is located. They will also be notified when it is appropriate to bring the pet in to the shelter. If a person finds a pet that they cannot care for, they are asked to e-mail Animal Care at admissions@broward.org.
The HSBC distributed thousands of pounds of food to pet owners in need.
Humane Society of Broward County
Special Measures Adopted to Face COVID-19 Crisis Like businesses worldwide, the Humane Society of Broward County gathered information, evaluated carefully and made changes accordingly as the COVID-19 situation unfolded. The shelter has many responsibilities to the animals at the shelter, to our staff and volunteers, and to the public and its pets. Many factors had to be considered. In mid-March we started to place many animals into foster homes. These were dogs, cats, rabbits and a Guinea pig, all who had been at the shelter and had been overlooked. More than 75 animals were able to enjoy the comforts of a family and home again. We are happy to report many of the foster families made the decision to adopt their foster pets. For those that can’t they have agreed to keep the pet until a permanent home can be found. Soon after the shelter moved to adoptions by appointment only. An adoption application was created and placed on the shelter’s website and potential adopters needed to fill out the application and could select 2 pets to meet with. Families were not allowed to walk through the building as previously done. Counselors and patrons were, and still are, required to wear facial masks for their appointments. Our behavior department and education department posted weekly videos to keep kids and dog owners informed and entertained. The admission’s department remained opened for emergency surrenders and end of life services. In addition, shelter staff continued pick-ups from many veterinary offices throughout the Tri-County area to perform private and communal pet cremations. In April, the HSBC offered a drive-thru food bank and distributed more than 7,000 pounds of pet food in one day to pet owners in need. Over the next few weeks, more than 25,000 pounds of food was distributed. If you have a client or know someone who is in need of pet food, please have them email info@hsbroward.com to see if we can assist. As businesses begin to re-open, new protocols have been put in place at the shelter. We hope to resume dog obedience classes, while social distancing, offer a revised kid’s camp this summer and more. Visit www.humanebroward.com to learn more.
Dr. James Anderson II Small animals, PT/relief
954-347-3557
doctor_anderson98@gmail.com
Dr. Peggy Carlow Small animals, PT/relief
954-303-6020 or 954-341-9552
pmcarlow@att.net
Dr. Diana Drogan Small animals, ER, relief
954-854-9426
dr.diana.dvm@gmail.com
Dr. Cindy Rigg relief/surgery, rehab therapy
305-968-8345
csrigg@yahoo.com
Dr. Dan Selvin Small animals, PT/relief
954-604-0084
dcselv4@gmail.com
Dr. Mark Steele Small animals, PT/relief, ER
754-235-1000 or 954-942-7193
mdsteele@bellsouth.net
Dr. Ana M. Tassino *Bilingual Small animals, clinic, surgery
305-335-3111
tassino@bellsouth.net
Dr. Claudia Valderrama
305-297-8893
claudia67v@aol.com
Dr. Stephen Waldman Small animals, PT/relief
561-214-3306
swaldman85@comcast.net
Dr. Fumiko Miyamoto Small animals GP/ER, PT/relief
352-339-2207
theasiandoctorllc@gmail.com www.theasiandoctorllc.com
Dr. Tolulope Ogunyemi Small animals, relief, surgery, dentistry
302-464-8387
reliefvet4@yahoo.com
Dr. Murray Deckelbaum
954-646-2586
murvet@aol.com
Relief Veterinarians
Classifieds & Advertising
This newsletter is published bi-monthly by the Broward County Veterinary Medical Association, Inc., 2801 E. Commercial Blvd., Ft. Lauderdale, FL 33308. Editorial Guidelines: Letters and articles are welcome. All submissions must be signed and the author's name will be published. Entries must be received 7 days prior to the publication date. Display Ads: Please e-mail all submissions to Lcarran@gmail.com. Views and opinions expressed herein are not necessarily those of the officers of the BCVMA. Products and services advertised herein are not necessarily endorsed. Membership Cost: $125 per year. For membership information, please visit BrowardCountyVMA.com or you can e-mail bcvma@mail.com. FOR SALE: HILLSBOROUGH COUNTY, FL : Solo, small animal practice near Florida’s Gulf Coast for sale! Some seller financing possible. $790k gross in 2019. Estimated ADI of +$136k can be expected.Approximately 4,300sq. ft. facility with real estate! Code: FL99 Contact PS Broker; 800.636.4740; info@psbroker.com; www.psbroker.com FOR SALE: VOLUSIA COUNTY, FL: Family owned, small animal practice with legacy to build upon for sale! Over $697k gross in most recent year. Estimated ADI of +$204k can be expected. Approximately 3,368 sq. ft., leased facility. Room to grow! Code: FL96 Contact PS Broker; 800.636.4740; info@psbroker.com; www.psbroker.com LEON COUNTY, FL: Long-established, welcoming practice with growth potential for sale! Over $744k gross in most recent year. Estimated ADI of +$129k can be expected. Approximately 1,978 sq. ft. facility with real estate. Build your own legacy! Code: FL97 Contact PS Broker; 800.636.4740; info@psbroker.com; www.psbroker.com VOLUSIA COUNTY, FL: Multi-DVM, small animal practice for sale! Seller financing available. Over $1.9 million gross in most recent year. Estimated ADI of +$282k can be expected. Approximately 3,086 sq. ft. facility with real estate. Great area! Code: FL98 Contact PS Broker; 800.636.4740; info@psbroker.com; www.psbroker.com
HELP WANTED: City College is seeking a full or part time veterinarian for its Veterinary Technology Associate program in Hollywood, FL. Qualified candidates will hold a Doctor of Veterinary Medicine degree (or equivalent) and be currently licensed to practice in Florida. Responsibilities include overseeing animal care on site, leading the teaching clinic, and classroom instruction. Teaching experience is preferred. For details or to submit resume please contact Kim Augustin at 954-744-1777 ext. 2022 kaugustin@citycollege.edu