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SOUTH FLORIDA VETERINARY MEDICAL ASSOCIATION
 


March / April 2017 Newsletter

    

      President's Message

    

From the desk of your President…

Happy Spring, everyone! 

We are very excited about a few events happening this season, starting with our C.E. meeting featuring Dr. J. Armando Villamil from Pet Cancer Group. It will take place on March 22, 2017 at the University of Miami. This oncology-themed meeting entitled "Cancer: It Doesn't Mean It's Over" has been generously sponsored by Heska and will elaborate on the strides our field is making in neoplastic diseases and finding treatment options for our patients.

Coming soon will be our highly successful "Night at the Swamp" meeting, scheduled for March 29th. This is the annual continuing education event we share with the University of Florida College of Veterinary Medicine (UFCVM) and the Broward County Veterinary Medical Association (BCVMA). This year's topic is anesthesiology and will be led by renowned UFCVM speaker, Dr. Luisito Pablo and an UFCVM update by Dr Michael Schaer. 

Additionally, our Spring Social will be held in conjunction with the BCVMA at Central Broward Regional Park (3700 NW 11th Place, Lauderhill, FL 33331) on April 2nd from 11 AM - 3 PM. There will be lots of delicious food, fun games, face painting, and music. This enjoyable event is open to all members and their families at a cost of $20 for adults and $30 for non-members (children eleven years and younger can attend for free) and is bound to be a great time.

SFVMA Board members attended an extremely successful event on January 26th at the Perez Art Museum to celebrate the new partnership between UFCVM and Miami-Dade Animal Services (MDAS). The event was very well attended. Moreover, the first two vet students from UFCVM to begin their shelter medicine rotation at MDAS were present. They were extremely excited about the educational opportunities ahead and felt the diversity of cases and exposure to a high caseload at our Miami shelter created a richer learning experience than what they had experienced at the Alachua Shelter. 

Though this program is still in its early stages, it seems like a great opportunity for a better working relationship between the SFVMA, MDAS, and UFCVM. We appreciate the contributions made by Dr. Rick Diaz, Alex Muñoz and UF Dean Dr. James Lloyd to develop this program. Our whole community will benefit from it.

Furthermore, we recently had a productive meeting with the ASPCA at MDAS and will have speaker Dr. Kristina J. Baucom, an ASPCA Forensic Veterinarian, offer a short presentation to our members about Animal Cruelty cases. This will take place in March during one of our CE meetings. 

Finally, Drs. Robert Swinger, Marta Lista and myself will be attending the FVMA legislative day on March 15-16 in Tallahassee. I am really looking forward to offering the entire SFVMA community some policy-making updates after our trip.

I look forward to your comments and concerns regarding our local veterinary community and especially appreciate your participation in all the philanthropic programs we along with the Miami Veterinary Foundation are engaged in. We are always looking for more volunteers and to your involvement with your local VMA! Please feel free to reach out to me with questions regarding the spay/neuter partnership and Project Unleashed at Camillus House. The caps for the spay/neuter partnership have been lifted at this time so we expect that our ability to offer the low-income community more low-cost spays and neuters will rise dramatically.

Thank you all and please stay involved with your local veterinary community. I look forward to seeing you at all of our upcoming events!

Sincerely,

Claudia Valderrama, DVM
SFVMA President and CE Chair
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Wednesday March 22, 2017



Armando Villamil, DVM, DACVIM (Oncology)
Oncologist at Pet Cancer Group

"Cancer: It Doesn't Mean It's Over"

Sponsored by: Heska 
Pet Cancer Group
 
Location:  Watsco Center
(Formerly: Bank United Center)
1245 Dauer Drive
Coral Gables, FL 33146
Hurricane Room
 
Registration: 6:30 PM  
Lecture:  7:30 PM 
Members: Included in Membership
Non-Members: $35.00
RSVP NOW
Wednesday April 12, 2017

 

Cherlene Delgado, DVM, DACVO
Ophthalmologist at Animal Eye Guys

"Avoid Disaster:
Don't let the Challenging Eyeball Cases Trample You"

Sponsored by Diamondback Drugs

Location:  Watsco Center
(Formerly: Bank United Center)
1245 Dauer Drive
Coral Gables, FL 33146
Hurricane Room
 
Registration: 6:30 PM  
Lecture:  7:30 PM 
Members: Included in Membership
Non-Members: $35.00

 
RSVP NOW
University of Florida College of Veterinary Medicine
     
March 29, 2017



                                      
Luisito Pablo, DVM, ACVAA
 
Michael Schaer, DVM
Interim Chair, Department of Comparative, Diagnostic & Population Medicine

"How to Safely Anesthetize Patients With 
Preexisting Heart Conditions"

Sponsored By: 
Zoetis
Diamondback Drugs
Hills Prescription Diet
Idexx Laboratories
Mobile Pet Imaging
Aratana Therapeutics
Medi-Law Firm

Location:  Watsco Center
(Formerly: Bank United Center)
1245 Dauer Drive
Coral Gables, FL 33146
Hurricane Room
 
Registration: 6:00 PM  
Lecture:  7:00 PM 
Veterinarians Only
RSVP NOW


by Lilian Bohorquez
 
Miami-Dade Animal Services is continuously finding ways to provide quality veterinary services for each of the thousands of homeless animals under our care each year. As one of the largest public shelters in the country, we have been able to save close to 90% of the pets entering the shelter. In order to achieve and maintain this type of success, we’ve partnered with rescues, animal welfare and veterinary organizations, and most recently with the University of Florida College of Veterinary Medicine (UF).  
 
With the support of County Mayor Carlos A. Gimenez and the Board of County Commissioners, on Monday, January 23, 2017 Miami-Dade Animal Services welcomed its first group of students in Shelter Medicine from the UF’s College of Veterinary Medicine.  This unique collaboration offers the students practical hands-on experience while at the same time helping to enhance spay/neuter services and intake physical examinations and evaluations for our shelter pets.  The UF College of Veterinary Medicine is known for its world-class shelter medicine programs. The students are overseen by a UF faculty member based at our shelter.  It’s a mutually beneficial partnership, and will offer our more than 30,000 homeless pets we take in every year,  invaluable services that can ultimately result in the best life-saving program of all—adoption into a loving forever home. 



Every week, Miami-Dade Animal Services receives approximately 500 dogs and cats.  Many have been neglected by their owners and never received any kind of veterinary care.  Others have either strayed from the safety of their homes or are simply abandoned because their owners were no longer able to care for them. Every dog and cat entering the shelter has a story. Regardless of the circumstances that got them to us, Miami-Dade Animal Services has the commitment to provide the best veterinary care possible.

As an emerging veterinary specialty, Shelter Medicine’s primary goal is to prevent disease in a shelter environment. With a weekly intake of close to 500 dogs and cats a week, we at Miami-Dade Animal Services share and fully embrace that goal. The result we all seek is that more homeless cats and dogs from our shelter can more quickly receive the health assessment and behavior training that is crucial to Miami-Dade Animal Services’ success in maintaining a no kill save rate. 

On intake our shelter pets receive physical examinations as well as routine testing for viral and infectious diseases, dermatological conditions, gastrointestinal and intestinal parasitism, as well as evaluations for behavioral concerns. Our in-house shelter veterinarians and veterinary technicians must then follow up and provide appropriate care and treatment including spay/neuter surgeries to help curtail pet overpopulation. The hands-on participation of the UF students is an invaluable resource that helps to more quickly prepare pets for adoption. 

Another invaluable veterinary partnership has been the Miami-Dade Animal Services funded spay/neuter program administered by the Miami Veterinary Foundation (previously known as South Florida Veterinary Foundation - SFVF).  Accessible and affordable spay/neuter services are widely considered to be a key element in reducing pet overpopulation. And as the only public shelter in Miami-Dade County, we have first-hand experience in pet overpopulation and that is why we’ve made spay/neuter a priority. Through this program, private veterinarians act as our partners in helping to provide low cost spay/neuter surgeries in their private practice.  From the inception of the program in June 2014 until September 2016, private veterinary offices in Miami have performed 6,463 funded spay/neuter surgeries. 

Just as we are working together with UF to ensure the health and safety of our shelter pets, we want to work together with private practice veterinarians who focus on the health of individual companion animals and help keep them in their homes.
 Chylothorax: A Surgical Perspective

 

Anatomy: 

Chylothorax results when chyle from the cysterna chyli or thoracic duct accumulates in the pleural space of the thoracic cavity.  Chyle is the fluid that arises from absorption of food in the intestines.  Dietary fats from food are absorbed by the enterocytes of the intestines as chylomicrons, which are large lipoprotein molecules that consist predominately of triglycerides, but also phospholipids, cholesterol, and other proteins.  These molecules are collected by lacteals, which are the lymphatics of the intestine.  Here they combine with lymphatic fluid to form chyle.  (Fossum T. W., et al. J Vet Intern Med.  2004., Singh A., et al.  Compend Contin Educ Vet. 2012)

After chyle is formed in the lacteals of the intestines it is transported to the mesenteric lymph nodes.  The cisterna chyli collects this fluid from the mesenteric lymph nodes acts as a reservoir.  In the dog it is an elongated saccular structure located ventral the first four lumbar vertebrae and to the right of the aorta.  In the cat it is a bipartite structure located ventral to the thirteenth thoracic to the third lumbar vertebra.  It is made up of saccular portion located to dorsal to the aorta and a plexiform portion located ventral to the aorta.  The thoracic duct is the cranial continuation of the cisterna chyli.  It continues from the cisterna chyli through diaphragm at the aortic hiatus.  In the dog it continues to the right of the aorta to the body of the fifth thoracic vertebrae then cross to the left side of the aorta and empties at the confluence of the left jugular vein and the cranial vena cava.  In the cat it continues to the left of the aorta and empties in the left jugular vein.  Variations in dogs include collateral vessels of the caudal and middle portions of the duct and double ducts systems as well as emptying in the mediastinal lymph nodes, right jugular vein, and azygos vein.  Variations in cats include multiple collateral vessels of the duct. (Slatter D.  Textbook of Small Animal Surgery.

Pathophysiology: 

Accumulation of chyle in the thorax results from impaired or disrupted lymphatic drainage.  The volume of chyle occupies space in the thoracic cavity and restricts lung expansion.  Chylothorax can lead to fibrinizing pleuritis.  This is the result of chronic inflammation due to presence of chyle inducing changes in mesothelial cells of the pleura.  Altered mesothelial cells produce and increased amount of collagen that leads to fibrosis.  Fibrinolysis is decreased and thought to be due to dilution of fibrinolysis promoters, such as plasminogen activator by chyle.  Thickening of pleura form dense fibrous tissue restricts lung expansion. (Tobias K. M., et al.  Veterinary Surgery Small Animal.  2012., Bojrab M. J.  Mechanisms of Disease in Small Animal Surgery.  2010.)

Causes:

Causes of chylothorax include anterior mediastinal masses consisting of thymoma, lymphoma, or ectopic thyroid carcinoma.  Heart disease such as cardiomyopathy, pericardial effusion, congestive heart failure, tetralogy of fallot, tricuspid dysplasia, cor triatriatum dexter, double chambered right ventricle, heart based tumors, and heartworms can also be a cause of chylothorax.  Other causes such as pulmonary neoplasia, lung lobe torsion, fungal granuloma, venous thrombi, congenital abnormalities of the thoracic duct, associated with intestinal lymphangectasia, and diaphragmatic hernias including peritoneal-pericardial diaphragmatic hernia have been implicated.  Trauma has also been associated with chylothorax, but is rare and usually resolves in few weeks.  The most common cause however is idiopathic and is thought to be associated with thoracic lymphangectasia. (Tobias K. M., et al.  Veterinary Surgery Small Animal.  2012., Bojrab M. J.  Mechanisms of Disease in Small Animal Surgery.  2010.

Signalment:

Afghan hounds and Oriental breed cats, such Siamese cats may be predisposed to chylothorax.  Clinical signs of animals with chylothorax may include coughing, tachypnea, shallow breathing, increased respiratory effort, decreased heart and lung sounds ventrally, and hyporesonance on thoracic percussion ventrally.  (Tobias K. M., et al.  Veterinary Surgery Small Animal.  2012., Bojrab M. J.  Mechanisms of Disease in Small Animal Surgery.  2010, Slatter D.  Textbook of Small Animal Surgery.

Diagnosis:

A thoracocentesis and fluid analysis can be performed to diagnosis chylothorax.  The fluid is white or pink in color and is opaque and remains so even after centrifugation.  Chylous fluid is classified as a modified transudate, with a total protein concentration between 2.5 and 4.0 g/dL, a cell count of less than 7,000/µL, and a specific gravity below 1.032.The predominate cell type are small lymphocytes initially, but chronic intrapleural inflammation and lymphocyte depletion cause nondegenerative neutrophils to predominate.  Comparing triglyceride and cholesterol concentrations between the serum and the effusion can be used to obtain a definitive diagnosis of chylothorax. If fibrinizing pleuritis is present lung lobes may fail to re-expand after fluid removal. Ultrasound is a useful diagnostic tool, for chylothorax in order to identify, sample, and drain fluid, as well as rule out causes of chylothorax. (Tobias K. M., et al.  Veterinary Surgery Small Animal.  2012., Bojrab M. J.  Mechanisms of Disease in Small Animal Surgery

Medical Management:

Medical management of chylothorax involves intermittent thoracocentesis to drain the pleural space and relieve respiratory distress.  A low fat diet is also employed to reduce the formation of chyle.  Bensopyrone also known as Rutin, is a medication that is believed to decrease lymphatic leakage, increase protein removal, increased macrophage phagocytosis, and increased proteolysis in cases of chylothorax.  Chronic medical management, however can lead to dehydration and loss of lipids, proteins, and fat soluble vitamins causing malnutrition.  Lymphocyte depletion can have effects on the immune system. Fibrinizing pleuritis can occur due to chronic exposure of the pleura to chyle, resulting in decreased lung expansion and respiratory difficulty.  (Tobias K. M., et al.  Veterinary Surgery Small Animal.  2012)

Surgical Approach:

A single right paracostal approach allows access to the mesenteric lymph nodes, cysterna chyli, and thoracic duct.  A right thoracotomy at the 8th, 9th or 10th intercostal space allows access to the thoracic duct and in some cases, the pericardium. Median sternotomy can be used to access the thoracic duct and the pericardium.  Cranial abdominal approach to access the mesenteric lymph nodes and cysterna chyli can be used along with a median sternotomy or transdiaphragmatic to access the thoracic duct and the pericardium.

Thoracoscopic access through portals placed in intercostal spaces or transdiaphragmatically provide good visualization for thoracic duct ligation and pericardectomy.  Identification of the cysterna chyli/thoracic duct can be achieved by administering oil or cream to the patient preoperatively or injecting methylene blue into a popliteal lymph node preoperatively or into a mesenteric lymph node intraoperatively. (Staiger B. A., et al. Vet Surg.  2011., Radlinsky M. G., et al. Vet Surg.  2002., Allman D. A., et al.  Vet Surg 2011., Mayhew P. D. et al. J Am Vet Med Assoc.   2012.)

Surgical Technique:

Thoracic duct ligation is accessed most readily via right thoracotomy at the 8th, 9th or 10th intercostal space. The overall success rate of this procedure is 59%. (Brichard S. J., et al. J Am Vet Med Assoc.)

En bloc ligation of the thoracic duct involves ligation of caudal mediastinal tissue dorsal to the aorta and ventral to the sympathetic trunk, which may include the azygous vein.  This technique is suggested to be technically easier, because it does not require isolation and ligation of individual branches of the thoracic duct.  It also does not require a means for identifying the thoracic duct, such as cream, oil, lymph node injection or lymphangiography. (Tobias K. M., et al.  Veterinary Surgery Small Animal 2012)

Pericardectomy can be combined with thoracic duct ligation for treatment of chylothorax. It is thought that thickened pericardium may increase systemic venous pressures, decreased drainage of chyle through the lymphaticovenous communications into the venous system, thus increasing lymphatic flow through the thoracic duct.  In a study of thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax by Fossum in 2004, 10 cats and 10 dogs were included.  Thoracic duct ligation and pericardectomy were performed in 17 animals and pericardectomy alone was performed in 3 animals.  Effusion resolved in 100% of dogs and 80% of cats at a mean follow-up time of 20.6 months. In a study of thorascopic thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax by Mayhew in 2012, 6 dogs were included. Effusion resolved in 100% of dogs at a mean follow-up time of 39 months.  (Fossum T. W., et al.  Vet Intern Med. 2004, Mayhew P. D., et al. J Am Vet Med Assoc.  2012)

Cisterna chyli ablation is thought to redirect chylous fluid by eliminating lymphatic hypertension, since chyle would be able to drain freely in the abdominal cavity.  In a study of the effect of cisterna chyli ablation combined with thoracic duct ligation on abdominal lymphatic drainage by Sicard in 2005, 9 research dogs were included.  Three dogs had thoracic duct ligation alone and six dogs had thoracic duct ligation and cisterna chyli ablation.  The combination successfully re-routed chyle flow into abdominal veins in 83% of dogs.  In a study of cisterna chyli ablation with thoracic duct ligation by Hayshi in 2005, 8 dogs were included.  The combination of procedures resolved effusion in 88% dogs with a mean follow-up time of 11.5 months. (Sicard G, K., et al. Vet Surg.  2005., Hayashi K., et al.  Vet Surg. 2005.)

Passive pleuroperitoneal shunts have a one way valve that shunt fluid from the thoracic to the abdominal cavity.  In a study of this system by Smeak in 2001, 14 dogs with nonseptic pleural effusion (71% chylous) were included.  The overall mean survival time was 27 months.  The mean time dogs were free of clinical signs was 20 months.  Complications were noted in 72 % of follow-ups.  Most complications can be successfully managed, but even when shunts are functional they may fail because of severe abdominal distension or excessive pleural fluid production may overwhelm the functional capacity of the shunt.  PleuralPort is a device for management of pleural effusion and can be used by owners to drain chylous effusion.  In a study by Brooks in 2011, six dogs and four cats (90 % with chylous effusion) were utilized.  No significant port migration, irritation, or infection of the device was reported. Median duration of port function was 20 days.  (Smeak D. D., et al. Vet Surg. 2001., Smeak D. D., et al. Vet Surg. 1987., Brooks A. C., et al.  Vet Surg.  2011.)

Omentalization is another surgical technique performed by bringing the omentum into the thoracic cavity either through the diaphragm or through as subcutaneous tunnel.  The omentum is thought to increase the venous surface area of the thoracic cavity and perhaps seal leaks in the thoracic lymphatics

Conclusion:

The reported success with surgery varies from 59% to 100% depending on the study and techniques used.  Case selection likely plays a significant role in outcome.

 

About the author:

Dr. Laura D’Amico is originally from Louisiana.  She received a Bachelor of Science degree with Honors from the University of Louisiana at Lafayette in 2005.  In 2009, she obtained her Doctor of Veterinary Medicine from Louisiana State University School of Veterinary Medicine.  She completed a rotating small animal internship at Auburn University College of Veterinary Medicine in 2011.  In 2013 she received a Masters of Science from Virginia Polytechnic Institute.  She completed a small animal surgery residency at Virginia-Maryland Regional College of Veterinary Medicine in 2013.  She is a member of the American College of Veterinary Surgeons (small animal). She is currently staff surgeon at Miami Veterinary Specialists.


Dr. Irving Lerner
MVF President

 
The Miami Veterinary Foundation (MVF) is NOT working under the radar anymore. We are doing many wonderful things including supporting efforts to manage and provide subsidized spay and neuter programs for at risk animals, delivering free veterinary care to the pets of indigent and low-income families and veterans, and offering free community lectures for pet owners, rescue workers, and animal lovers –– just to name a few. Our Board has been working tirelessly to manage the aforementioned programs while rebranding the Foundation with a new name, logo, and website that is really beautiful to see. Our message will become more clear and concise with an entire interactive website that will be located at MiamiVetFoundation.com. Please check it out.

Our SPOTS Program, Students Providing on Campus Training Services, recently made the front page of the Miami Herald. The program is hosted by Felix Varela High School and serves to educate students about the issue of overpopulation-related pet death in this county, to offer supportive behavioral training initiatives for dogs adopted from Miami-Dade Animal Services, and to serve as a liaison for programs working towards the goals of reducing shelter deaths. At-risk dogs are selected from MDAS under the guidance of Dr. Karen Ashby, certified trainers, and Chris Septer, our MVF executive director. Students teach the dogs behavioral and life skills to help the dogs become the best Canine Good Citizens they can be. Thereafter they help them find their forever homes.

The Spay and Neuter Partnership between the thirty participating hospitals and Miami-Dade County, administered by the MVF, is now back in full operation –– without limitations. $300,000 was again granted by Miami-Dade County to sterilize qualified individuals pets and community cats. Last year the program was so successful we had to suspend the program until more funds became available for this fiscal year. Please contact us if you are interested in participating in this important public service program. It helps show the community how much we really care about pet overpopulation, low-income pet owners and animal welfare in general.

Our Friends of the Foundation Lectures offer free public education lectures on various topics pertinent to animal care. These lectures are led by local veterinarians and are targeted to para-professionals, canine sport enthusiasts, rescue groups, veterinary technicians and anyone else who has an interest in our topics. Friends of the Foundation hosts its lectures at the University of Miami. Dr. Pedro Armstrong from Mobile Pet Imaging is so kindly lecturing and sponsoring our next lecture on March 9. The topic is “How can a CT scan help my pet.” Please check our website for times and lecture halls for this lecture and other upcoming events.

Dr. Irving Lerner
MVF President
 
               SFVMA BOARD OF DIRECTORS

President: Dr. Claudia Valderrama
Immediate Past President: Dr. Robert Swinger
Vice-President: Dr. Kenny Snyder
CE Chair: Dr. Claudia Valderrama
Recording Secretary: Dr. Patty Khuly
Treasurer: Dr. Maria Oliveira
Social Media/WebmasterDr. Marc Kramer
FVMA District VI Representative: Dr. Marta Lista
MVF President: Dr. Irving Lerner
Executive Director: Maria Reyes, CVT

BOARD MEMBERS:

Dr. Gerardo Diaz
Dr. Rick Diaz
Dr. Simon Kornberg
Dr. Sharon MacIvor
Dr. Laurie Rodriguez

Are you planning on attending a conference this year?
The FVMA has two world class conferences a short drive away from us. The Annual Conference at the Tampa Marriot is April 7-9 and the Gulf Atlantic Conference at the Boca Ratón Waldorf Astoria is Dec 1-3. In addition to enjoying great conferences, by attending FVMA conferences you are directly supporting the FVMA. 

On March 15 & 16, the FVMA is hosting its Annual Legislative Action days. This year Drs. Swinger, Valderrama, and I will be joining our colleagues from across the state in Tallahassee to support the bills the FVMA is sponsoring. While there we will also defend our policy position on bills presented from outside groups.

The success of our conferences, in addition to your dues and the various other FVMA programs, has made the FVMA one of the largest state associations and given us a powerful voice in the legislature while maintaining one of the lowest membership dues in the country. The FVMA works to protect the interest of all veterinarians in Florida. 

Thank you for your continued membership in the FVMA.
Marta Lista DVM
FVMA District 6 Representative

 
Tattooing Sterilized Pets:
Setting the New Standard



Marc H. Kramer, DVM

Have you ever attempted to spay a female dog, only to discover in the middle of abdominal surgery that her reproductive tract was already removed? Ever thought twice about that "neutered" male cat or dog in your exam room with no palpable testicles and wondered if he could actually be bilaterally cryptorchid? How many of you have been caught trying to accidentally spay a neutered male cat? Anyone ever question the origin of an dubious midline abdominal scar and wonder if it was a from a spay, a C-section, or maybe just a wound from a fight? If you've found yourself in any of these situations, then you'll understand how a 10-second placement of a little tattoo ink after a spay or neuter could save you and your colleagues a lot of headaches, cut back on unnecessary anesthesia, save time and money, and prevent pets from undergoing redundant surgery. If these unfortunate events haven't happened to you yet, it's only a matter of time before they do! I'm here to convince you to adopt some new standards for the tattooing of dogs and cats (and exotic pets, too) concurrently with spay and neuter surgery.

Marking a sterilized pet with a tiny dab of green tattoo ink after they are spayed or neutered is now a standard procedure in shelters, humane societies, and high-volume spay/neuter clinics around the country. It serves to remove all doubt as to whether an animal has been sterilized. I strongly recommend that veterinarians in private small animal practices adopt the same standards. Relying on surgical scars alone can be problematic, as they are not always discernible. When surgery is performed on pediatrics, patients recover faster than adults and as they grow, their surgical site heals leaving no palpable or visual spay or neuter scar. Pets that you see today in your clinic may wind up in a shelter facility tomorrow and their medical records don't travel with them, but a sterilization tattoo does. Shelter vets and vets in small animal practice alike can breathe a sigh of relief when a sterilization tattoo is found on an animal with an unknown sterilization history. It unequivocally confirms that pet's status as sterilized, removes uncertainty, and prevents an unnecessary exploratory surgery +/- advanced diagnostics from taking place.

Green tattoo paste (Ketchum Manufacturing, Inc.), available through most veterinary distributors at just a few dollars for a 1 oz. tube, will provide you with more than a year's supply of ink. It produces crisp, permanent tattoo marks that are legible for the life of the animal. Green is chosen as it can not mistaken for normal pigmentation. A smidgen of ink is placed in the surgical incision (or a superficial skin score made adjacent and to the right of the incision) using the back of a scalpel blade or a sterile autoclave indicator strip. Surgical glue is placed over the tattoo ink to seal it in place.

For female cats and dogs:
Using the back of the scalpel blade or a sterile autoclave indicator strip, place a <1 cm stripe of green tattoo ink on the skin edge of the spay incision. Alternatively, score the skin (partial thickness only) adjacent and to the right of the incision and place the tattoo in the skin score. Seal over the tattoo ink with tissue glue.



For male dogs:
Using the back of the scalpel blade or a sterile autoclave indicator strip, place a <1 cm stripe of green tattoo ink on the skin edge of the pre-scrotal incision. Alternatively, score the skin (partial thickness only) adjacent and to the right of the prepuce and place the tattoo in the skin score. Seal over the tattoo ink with tissue glue.



For male cats:
The standardized location for the male cat tattoo is on the ventral midline abdomen, caudal to the umbilicus, in the location where a spay incision would be made on a female cat (approximately one-third to one-half the distance from umbilicus to pubis). The reason for this location is that neutered male cats are sometimes mistaken for females, and if tattooed there, it will be visualized when the cat's abdomen is shaved. A 3x3 cm square of fur caudal to the umbilicus should be shaved and cleaned during surgical prep. Following the neuter, score the skin (partial thickness only) in this location and place the tattoo in the skin score. Seal over the tattoo ink with tissue glue.

This simple, quick, and inexpensive procedure prevents the waste of our and our colleagues' time and resources in determining whether an animal of unknown history is sterilized or not. Whether an animal is examined at a shelter, in private practice, or on the street, the visualization of a sterilization tattoo is priceless and helps us to immediately confirm its spay/neuter status.

About the Author:
Dr. Marc Kramer is a veterinarian of all creatures, focusing in two unique fields: avian & exotic animal medicine and spay & neuter surgery. Originally a New Yorker, he graduated with a B.S. ('94) and D.V.M. ('99) from Cornell University and then completed an avian and exotic specialty internship at the Ontario Veterinary College. Following his veterinary training, he relocated to South Florida in 2000 where he began practicing exclusively with birds and exotics. Today, Dr. Kramer is licensed to practice in six U.S. states and serves as a per diem vet at exotic animal practices, vet schools, and wildlife facilities around the world. Additionally, he contributes intensive spay and neuter efforts in Miami to help lower the euthanasia rates in South Florida shelters. After his first 40,000 spays and neuters, in 2013 he co-founded Project PetSnip, a charitable veterinary program in Miami that strives to make an impact on reducing pet overpopulation in our community through high-quality high-volume spay and neuter.

Pet Poison Prevention Week

March 18-24, 2017

Six reasons why we should be sharing more of our cases with toxicologists
(just in time for Pet Poison Prevention week, March 18-24)

Meet the most underutilized, undervalued veterinary specialist in clinical veterinary practice: the toxicologist.

It’s true. Toxicologists get short shrift in everyday clinical practice. Think back: when was the last time you shared a case with a remote toxicologist? If you’re like most of us it’s probably been a while.

You either a) (like me) tend to forget that a toxicologist is only a phone call and fifty bucks away (in most cases it’s pretty inexpensive) or b) never realized that using a remote toxicologist routinely was a “thing,” one that could immeasurably improve your patient care.

Yes, the poison control hotline is not just for our clients. It’s for us, too.

Once viewed as a veterinary resources for pet owners alone (and one that potentially cannibalizes our revenues), toxicology in vet medicine has come a long way. No longer is this the specialty service for chocolate toxicity and plant ingestions. Not at all.

Sure, modern toxicology is still available to all our clients via poison control services, but it’s also there so Joe Vets like me can offer advanced, specialty-level patient care in a general practice setting. Here are five reasons why doing so makes sense:

#1 A higher standard of care

According to toxicologists, a toxicologic diagnosis is based on a) a detailed patient history b) a list of clinical signs and physical examination findings c) evaluation of appropriate specimens by a toxicology lab and d) prudent interpretation of the laboratory results.

All facets of this process can be facilitated by a toxicologist, should you choose to engage one. They’ll help you with your history-taking (“Did you happen to ask about …?”), direct your fingers during a physical exam (“What did the kidneys feel like?”), recommend specific laboratory tests and help you put it all together.

And after they’re done helping with all that? They’ll recommend a treatment plan, including a long-term diagnostic plan and plenty of opportunity for following the case along as needed.

#2 Fewer missed diagnoses (and liability issues)

Fuzzy history? Possible exposure to toxins? Still can’t put your finger on it?

Just as it’s never wrong to screen for pancreatitis in gastroenteritis cases, using a toxicologist in hard-to-pin-down liver and kidney cases (among other possibilities) is never a bad thing. In fact, your clients will probably wonder why you’re not looking closely at the possibility of poisoning. Which brings me to my next point:

#3 Higher perceived client value

I don’t think I’ve ever had a client complain about the expense of a tox consult. For some reason, poisoning is one of those possibilities they’re most concerned about. As such, they readily understand the value of asking a toxicologist to weigh in. In fact, when you tell them you’re consulting a remote toxicologist they’ll be impressed. I promise.

#4 A smarter, more engaged you

It’s inevitable. Using a toxicology consult service means you’ll learn more about toxicology, critical care and internal medicine in general. Why would you deny yourself this opportunity? –– especially when …

#5 It’s easy and inexpensive

A tox consult service is only as far away as your favorite veterinary poison control service. Most of these charge well under $100 (usually around $50) and tend to be available for followups … unlike most specialists I tend to run across.

Then there’s the obvious benefit to consider…

#6 Higher revenues

When you’re able to practice higher quality medicine without having to send every patient to the criticalist or internist, higher revenues are never far behind.

Now that you know how to get smarter and build your practice … what are you waiting for?

Relief Veterinarians:
Karen Ashby   Angela Guevara Nieveen
drkarenashby@aol.com   asupervet@yahoo.com
305-401-1266   352-318-1703
     
Doly Baquero   William Marks
dolybaquero@aol.com   williammarksdvm@gmail.com
786-234-1946   305-733-0007
     
Katarina Boros   Ruben Nasio
boros305@gmail.copm   rndocvet@bellsouth.net
305-981-4721   786-443-6218
     
Peggy Carlow   Mark Steele
pmcarlow@att.net   mdsteele@bellsouth.net
954-303-6020   954-942-7193
     
Keiko Hirokawa   Claudia Valderrama
khirokawa@gmail.com   claudia67v@aol.com
734-730-1059   305-297-8893
CLASSIFIED ADVERTISING
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Contact: Dr. Marc Kramer at exoticdvm@mac.com or 305-215-2232

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