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President's Message
From the desk of your President…
I start this New Year optimistic for a wonderful 2017 as your new SFVMA President. Having been very involved with our association over the last few years, from coordinating our monthly continuing education meetings to developing our digital newsletter, I greatly look forward to the leadership opportunities in my new role. Moreover, I am eager to enhance my professional relationship with many of you. Please feel free to forward me your input regarding any issues or concerns impacting our veterinary community and in finding beneficial solutions that serve both veterinarians and the public.
Our veterinary profession is changing. Veterinarians can increasingly provide state-of-the-art care for their patients equivalent to human medicine. Veterinary practices are more frequently being sold to large corporations. Taking political action for animals has become more commonplace in society. The roles of municipal animal shelters, low cost veterinary services and rescue groups continue to gather great interest by the public. This in turn puts more pressure on veterinarians competing with those organizations. To create a better image for our veterinary profession, we need to find an appropriate balance between being excellent leaders, compassionate doctors, and savvy business professionals.
We need to ensure a good public image for our profession and our organization, to stay ahead of negative press, and to be proactive rather than reactive. One way I hope to accomplish this is to work closely on philanthropic collaborations with the Miami Veterinary Foundation and enhance our reputation with the public.
Another important goal of mine is to have improved communication with Miami-Dade Animal Services, especially as the University of Florida College of Veterinary Medicine begins its new collaborative effort with them. I welcome any suggestions that can enhance the progress the task force has accomplished so far, and move forward resolving any issues in a positive manner to benefit our veterinary community.
Lastly, we have great monthly continuing education meetings scheduled for this year. Our first meeting on February 22nd, the 3-credit Pharmacy & Florida Laws and Rules program, will be presented by Pharmacist Kirk Huffaker, Attorney Max Adams and Dr. Mark Steele who have generously donated their time to our association. Our “Night at the Swamp” meeting speaker on March 29th will be Dr. Andre Shih, anesthesiologist and a fabulous speaker, with an amazing following by the BCVMA members. We expect great attendance and terrific sponsors for this event.
We are very excited to welcome our new board members, Dr. Simon Kornberg and Dr. Laurie Rodriguez, and look forward to their input on social media and helping us reach out to the new generation of SFVMA members.
Please don’t hesitate to reach out to me with any questions or concerns, and I look forward to seeing you at our C.E. meetings and Spring and Holiday Socials.
Sincerely,
Claudia Valderrama, DVM
SFVMA President and CE Chair
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Did you hear?
It's time to renew your membership!
Click here to print and mail
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UPCOMING CE COURSE
Wednesday, February 22th, 2017
Sponsored by: Roadrunner Pharmacy
"Pharmacy, Laws, and Rules"
3 CE Credits
Speakers:
Kirk Huffaker, RPh, Dr. Mark Steele,DVM and Max Adams, JD
Licensed veterinarians in Florida shall complete a minimum of thirty (30) hours of continuing professional education in veterinary medicine every biennium.
Beginning on June 1, 2012, no less than one (1) hour of continuing education shall be in the area of dispensing legend drugs and no less than two (2) hours of continuing education shall be in the area of the laws and rules governing the practice of veterinary medicine.
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Trupanion. More than just pet insurance. Medical insurance for cats and dogs you can count on.
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MIAMI VETERINARY FOUNDATION UPDATE...
Friends of the Foundation,
I hope that 2016 was a productive, happy, and most importantly, a healthy year for all.
We are excited to announce that after consultations, discussion and thoughtfulness, the Board of Directors felt that changing our name to the Miami Veterinary Foundation (MVF) best reflects who we are, the community we serve and allows us our best branding advantage.
We hosted our Vets Fore Pets Golf Tournament on Friday November 18th. A huge thank you to our Sponsors and to all of you who played in or volunteered at the event. Your support made this year's golf tournament the Foundation's largest fund raising event to date.
As we make our transition to The Miami Veterinary Foundation name, some South Florida Veterinary Foundation things may still show up. We endeavor to keep any confusion to a minimum, rest assured we are one and the same organization.
The Foundation is a charitable organization. This means volunteers and donations are what make us possible. Our dedicated volunteer Board of Directors has worked tirelessly this past year to continue to provide veterinary care, education, and expertise to facilitate the various individual programs the Foundation provides on behalf of the animals and pet owning community in Miami.
The spay/neuter partnership with Miami-Dade County has again been funded in the amount of $300,000 for 2017. This program's thirty participating animal hospitals have neutered over 6000 pets in the past two years. MDAS and MVF are now planning fundraising events to supplement the annual allowance awarded so we do not run short of funds as we did last year. We will need everyone's participation in making fundraising a successful endeavor. So please be on the lookout for these announcements.
Students Providing On Campus Training Services (SPOTS), a MVC-PUPE program, is our new collaborative partnership with Varela High School, MDAS, local dog trainers, and the MVF. This program allows untrained dogs pulled from MDAS to become AKC Canine Good Citizens and find forever homes. As a result of the great training received, many previously unadoptable dogs can be re-homed, helping to free up the shelters. Dr. Karen Ashby, the program director, Yleana Escobar, the lead teacher, Susan Claire, volunteer head trainer, Chris Septer, MVF executive director and host counselor, and twelve devoted student handlers deserve kudos for an incredible job very well done. The program's first class graduation this past Dec. 4 was impressive and heart-warming. I will post future graduation class dates so you too can attend and support this wonderful program.
The MIAMI VETERINARY FOUNDATION moves in to the future of 2017 with the same pro-active mission to increase access to quality veterinary care, promote responsible pet ownership, increase awareness of the importance of the human-animal bond in our community and support the effort to reduce pet over population in Miami.
Wishing everyone a Happy, Healthy New Year. We appreciate your support and participation in 2016 and look forward to having you join us in 2017!
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88th Annual FVMA Conference
April 6-9, 2017
Tampa Bay Convention Center
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Vestibular Syndrome
Vestibular syndrome is one of the most commonly encountered neurologic conditions in veterinary medicine. It is also one of the most distressing to owners and patients. Due to the severity, acute nature and poorly understood pathophysiology it is also often “misprognosticated”, usually to the detriment of our patients.
First of all, it is important to know that vestibular syndrome, like seizures is not a diagnosis, but a clinical sign that occurs from a wide variety of defects in a specific part of the nervous system. Therefore, it is extremely difficult to diagnose and therefore provide an accurate prognosis based on presentation alone. Secondly, vestibular syndrome may be either peripheral or central. This is a distinction, which can often be made on neurologic exam, and can have huge ramifications on diagnosis and prognosis. Vestibular syndrome’s causes can range from relatively benign, such as otitis media/interna or idiopathic to serious such as encephalitis, brain tumors or stroke. Accurate diagnosis is essential in order to come up with an appropriate treatment plan or direct clients as to whether a condition is likely to improve or not.
The most common presentation of vestibular disease is often an older patient with sudden onset head tilt, nystagmus, difficulty walking and sometimes vomiting or inappetance. However, young dogs and dogs with only one or a combination of these signs can also present.
Vestibular syndrome can present as either central or peripheral. Simply put, central vestibular syndrome refers to a central nervous system localization, ie. Vestibular nuclei in the brainstem, the cerebellum or multifocal disease. Peripheral vestibular syndrome localizes to the peripheral nervous system, this is usually the middle/inner ear, affecting the semicircular canals or peripheral nerves. The two most common causes of peripheral vestibular syndrome are otitis media interna and idiopathic vestibular disease. However, neoplasia, vascular events, toxins, trauma, metabolic disease can also be implicated. Central vestibular disease localizes to the central nervous system. Specifically, the vestibular nuclei, the caudal cerebellar peduncle and the flocullonodular lobe. It generally carries a less favorable prognosis than peripheral vestibular disease due to the location and list of differentials. These differentials include neoplasia, vascular events, trauma, toxic, infectious or inflammatory disease.
My approach to diagnosis and treatment is relatively straightforward, and I would never give a prognosis to a client without following a thorough diagnostic approach.
A thorough history is essential. A video is even better! Often we can narrow down our differential list based on breed, chronicity, progression, onset and nature of the signs. History of ear infections, skin infections, access to toxins, comorbidities and certain medications can also tip us off as to the cause of the presenting signs. Physical examination is extremely important. Paying special attention to the heart, ears, eyes, hair coat and body condition score should be done as they can give clues as to whether the patient has any comorbidities such as hyperadrenocorticism, hypothyroidism, otitis externa/media/interna, or cardiac issues. Otoscopic examination is also essential! While, a patient with an intact tympanic membrane is less likely to be suffering from otitis media/interna, some patients, most notably Cavalier King Charles Spaniels can have a condition known as primary secretory otitis media (PSOM), which doesn’t necessarily show evidence of a ruptured tympanic membrane. Furthermore, some patients with chronically treated ear infections may have had a membrane, which has since healed, trapping infection inside. Please note, that finding evidence of severe ear infection with tympanic bulla involvement does not mean this is the cause of the problem, but if the client does not want to pursue further diagnostics, this is a great place to start treatment.
Following this, a thorough neurologic examination is needed. This includes not only noting head tilt and nystagmus direction, but ALL cranial nerves I-XII, level of consciousness, gait assessment, postural reactions and positional disturbances. This is by far the most cost effective way to make a tentative diagnosis and therefore as accurate prognosis as possible without advanced diagnostic modalities.
Vestibular syndrome is actually caused by a lack of BALANCE between the input from the vestibular nuclei on each side. Generally at rest, there is a resting tone coming from the sensors to the nuclei, in the event of a middle ear infection or a lesion affecting the vestibular nuclei there is LESS input on the affected side, this “tricks” the nervous system into thinking it is falling AWAY from the affected side. The body compensates, by falling TOWARDS the side! The exception to this rule is with paradoxic vestibular syndrome in which the inhibitory pathways to the vestibular nuclei are affected, causing an INCREASE in tone on the affected side.
The classic picture of a dog with peripheral vestibular disease is an alert patient with a head tilt to the side of the lesion, a HORIZONTAL or ROTARY nystagmus away from the lesion (generally opposite the head tilt), ataxia and falling to the side of the head tilt. These patients generally have NO postural deficits. This is the major key in differentiated central and peripheral vestibular disease but can be hard to ascertain in a severely affected patient. In addition to this, there is often extensor rigidity on the contralateral side to the head tilt and rolling. This should not be confused with a postural deficit. Further evidence of peripheral vestibular disease includes Horners’ Syndrome and facial nerve paralysis with NO OTHER CRANIAL NERVES INVOLVED. This suggests involvement of the tympanic bulla, where CNVII and the sympathetic innervation the orbit passes through. Nystagmus should not change based on head position, but in some patients it can be exacerbated with rotation to the side of the lesion.
I tend to pair central and paradoxical vestibular syndrome together as they are both lesions affecting the central nervous system and therefore have a similar list of differentials. Patients with central vestibular syndrome are generally more severely affected and can exhibit rolling. They may have rotary, horizontal and sometimes VERTICAL nystagmus. The latter while being strictly associated with central disease, can on occasion be seen in peripheral disease or confused with rotary nystagmus. In my opinion it is is not an accurate way to determine the localization. These patients often have a diminished level of consciousness and a nystagmus that changes with head position. The most reliable differentiation points between central and peripheral vestibular disease, is additional cranial nerve deficits and postural reaction deficits in centrally affected dogs. In classic central disease, the head tilt and rolling will be toward the side of the lesion, while the nystagmus will have a fast phase away (if applicable). This localizes to the vestibular nuclei of the brainstem. Paradoxical vestibular disease has a head tilt AWAY from the lesion, and a nystagmus with a fast phase TOWARD the lesion. This indicates that a specific location is affected; the caudal cerebellar peduncle. The next question that you may be thinking is “How do I know where the lesion is?” Answer: Follow the postural deficits. In central vestibular disease, head tilt will be toward the postural reaction deficit, while nystagmus will have a fast phase away from it. In paradoxical vestibular syndrome, the fast phase will be toward the postural deficit, and the patient will be leaning away from it. Please note, these rules only apply to central lesions.
Once we have our localization we can generate a list of differentials, prioritizing them based on signalment, history and clinical examination. A more accurate tentative diagnosis can be attained, allowing a more accurate prognosis for clients.
Differentials for peripheral vestibular disease include idiopathic vestibular disease, aminoglycoside toxicity, vascular events, hypothyroidism, cushing’s disease, otitis media/interna, neoplasia and parasitic migrans. Major differentials for central disease includes: neoplasia, meningoencephalitis, stroke, trauma, metronidazole toxicity, trauma and parasitic migrans.
Ultimately, however, ALL vestibular syndrome cases can benefit from further diagnostics. Further diagnostics should include full bloods including thyroid panel, ACTH stimulation test if indicated and coagulation panels. Following this advanced imaging such as a high field MRI should be done. This allows us to differentiate between the various causes of vestibular syndrome with greater sensitivity and specificity than CT scans. It gives us an in depth look at the brain as well as the middle/inner ear, often revealing information that is not visible with even the most thorough otoscopic examination. In the event of no findings a CSF analysis should be performed, allowing us to get an inside look at any infectious or inflammatory processes occurring. Only once we rule out all other causes, can we comfortable make a diagnosis of idiopathic vestibular syndrome.
Treatment is aimed at the underlying causes. If further diagnostics are an option, steroids and antibiotics should be withheld. Once the cause is found, further diagnostics and treatment modalities can be directed to address the problem. For cases of idiopathic vestibular disease, these are generally self limiting, however, symptomatic therapy may be pursued. Symptomatic therapy is controversial and is usually aimed at alleviating nausea, sedation and decreasing vestibular sensitivity. I tend to prefer diazepam for empirical therapy as it has vestibular suppressing effects as well as sedative effects. An additional benefit is that it stimulates appetite in dogs that may be nauseous. Other options are meclizine, maropitant or metoclopramide. If a suspected otitis media/interna is found, culture and sensitivity is recommended prior to commencing antibiotics. This may be done by otoscopic sampling, myringotomy or bulla osteotomy. Empirically, I prefer to use cephalexin or amoxicillin. Although I generally prefer treatment based on culture and sensitivity.
Due to the wide variety of causes, it is beyond the scope of the article to go into treatment for each individual etiology. However, the most important thing we can do for our patients and clients is to provide as accurate information as possible by going through each diagnostic step. From here, we can direct treatment as needed, improve outcomes and prevent patients from unnecessarily bad prognoses.
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Thank you to all our sponsors & members that participated in the fabulous SFVMA Holiday Party.
It truly was Miami Chic!
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VETERINARY FEED DIRECTIVE IN 2017:
Effective January 1, 2017, the U.S. Food and Drug Administration (FDA) is implementing stricter rules regulating how antibiotics can be administered to animals in feed and drinking water. Veterinary oversight is now required whenever “medically-important” antibiotics are administered to any food animal species via feed or water, even if the animals are not intended for food production. For those of you practicing exclusively with dogs and cats (which thankfully are NOT food animal  species in this country!), this may not affect your everyday routine, but is still important as a veterinarian to recognize.
Addressing a growing concern in the U.S. on bacterial resistance to antibiotics, the new Veterinary Feed Directive (VFD) aims to regulate the medicating of food animal species. This insures that antibiotics are used responsibly and do not pose a risk to human health. Additionally, the new directive discontinues the sub-therapeutic use of medically important antibiotics for growth and maintenance purposes; antibiotics can now only be labelled for disease treatment, control, and prevention.
What the FDA considers “medically important” antibiotics are commonly used antibiotics such as tetracyclines and penicillins, along with classes of drugs critically important to human medicine, such as cephalosporins, fluoroquinolones, sulfas, and aminoglycosides. To make matters more confusing, the use of some livestock medications will not change under these new regulations. Specifically, the use of non-medically important feed-grade products such as monensin, lasalocid, bacitracin, carbadox, tiamulin, narasin, bambermycin, and most coccidiosis medications will not change since they’re not considered important in human medicine.
What species of animals does this affect? Any food animal species, even if they are not intended for food production. This includes but is not limited to species such as rabbits, pigs, fish, poultry, goats, sheep, cattle, horses, and even honeybees. Yes, honeybees can be dispensed antibiotics for certain diseases and beekeepers may very well call on you now for veterinary advice. Small animal practices may see the occasional backyard chicken, pet rabbit, or pot-bellied pig -- and these rules will apply to these patients. That said, the VFD only regulates antibiotics administered via feed or water; it does not apply to prescription drugs administered via other routes.
 Antibiotics that were previously available over-the-counter will now require a VFD from a licensed veterinarian. A VFD is similar to a veterinary prescription, and can only be issued by a licensed veterinarian based on a valid veterinarian-client-patient relationship. Through this relationship, the veterinarian will assume responsibility for the clinical judgments on the patient's or herd’s health. They must establish sufficient knowledge of the herd through examination and visits to the facility. The veterinarian must fill out an appropriate VFD form, specifying the animals to be treated, the drug to be used, its feeding rate, and the duration of treatment. According to the regulations, the veterinarian will also indicate an expiration date on the VFD, not to exceed 6 months. The veterinarian, owner, and feed mill all need to keep a copy of the VFD on file for two years.
A close relationship between a client and a veterinarian is an important step in making decisions about feed-grade antibiotics. In the long run, we can expect reduced antibiotic resistance, less time and money wasted on ineffective medications, and increased dissemination of practical advice and knowledge to help prevent the illnesses that require antibiotic use in the first place.
Useful Links:
STEPS to determine the need for a VFD or Prescription
How to complete a VFD Form
VFD Form
AVMA PLIT Risk Awareness Alert on the VFD
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FIVE REASONS YOU SHOULD BECOME MORE ACTIVE IN THE SFVMA
While in vet school I participated in student government primarily because I couldn’t keep my mouth shut about anything and liked to think I could influence things most people judiciously consider beyond their control. Nonetheless I never really thought I’d want to participate in my local veterinary medical association. Too parochial. Lots of small picture irrelevancies to get tangled up in unnecessarily.
Twenty years later I’m eating those words. Perhaps the petty stuff, small-mindedness and ego mongering happens in other VMAs but I wouldn’t know. Ours is the only one I’ve ever participated in. And ours is nothing if not effective at CE, wonky about local veterinary-related issues, and truly concerned about the welfare of all local veterinarians.
Unfortunately, however, the South Florida Veterinary Medical Association does have its Achilles heel. We suffer from a chronic inability to recruit membership for participation in activities beyond our CE stomping grounds at The U.
We need more people like you to engage more energetically with us at all levels, whether it’s by serving on the Board (positions are always on offer!) by joining us on the first Monday of the month at our Board meeting at Seasons 52 in Coral Gables, or by simply attending fundraising events like the fishing and golf tournaments and, of course, our annual holiday party.
Think you don’t have the time? That’s probably not true. Most of you can probably eke in an hour for dinner at Seasons 52 one night a year or help spread the word of our excellent events through your workplaces.
Think there’s nothing in it for you? Think again. There are plenty of perfectly selfish reasons to participate more thoroughly in VMA exploits:
#1 Continuing Education
OK so this is the obvious one. Our famous CE events are the number one reason you’re likely to be a member of the SFVMA. Our monthly meetings are always well attended and highly successful opportunities for learning and CE credit accumulation.
#2 Entertainment
Think your social life lacks some zing? We can help with that! If you attend all our events you’ll have experienced almost thirty more fun new adventures than you otherwise would have. Those of you new to South Florida, especially, will find that your membership is not only ridiculously well priced given the food and drink options at our events, it’s an effective way to meet like-minded people.
#3 Networking
Rubbing elbows with fellow veterinarians can be fun and profitable! Looking for that perfect forever job? Seeking a great new hire? Want more opportunities in whatever your veterinary niche might be? Your VMA is the place where giving to your community and getting from your community intersect perfectly.
#4 Influence
Frustrated over one or more veterinary issues? Want your voice heard? Being part of the VMA, especially at the Board level, is a great way to influence the direction of local policy on issues you may care deeply about. Whether it’s animal welfare, shelter politics or random County ordinances or policies, you have more power than you think you do when you participate.
#5 Veterinary Karma
Playing an active role in your local veterinary association grows the power of your own personal karma. Really. That’s because being active in any VMA helps further the principles we pledged to in our Veterinary Oath, principles that help animals and the wider community along with ourselves. And that’s what it’s all about, isn’t it?
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Humane Society News2017 WALK FOR THE ANIMALS
Join us for our largest community fundraiser that brings thousands of animal lovers together to walk the walk and show their support for all of our four-legged friends. On Saturday, March 4, 2017, people and packs of all sizes will gather together at Bayfront Park, Miami, for a morning filled with tons of fun under the sun. Join more than 3,000 animal lovers with or without a dog for a fun stroll around the park and a morning filled with fun for the whole family. There will be music, food, activities, games and plenty of fun for dogs and the people they own! We will have a great " Adoption Arena" where local rescue groups will have dozens of adoptables looking for loving, forever homes. Every dollar raised from the Walk will go toward sheltering up to 400 homeless cats and dogs in our care every day.
How can you get involved?
- Raise funds for the Walk for the Animals among your family, friends and coworkers. CLICK HERE to register and start your fundraising today!
- Your business, or the company you are working for, could sponsor the event. With over 3,000 people attending each year, 20,000 brochures distributed, and a great advertising schedule - this is a fabulous marketing opportunity. CLICK HERE to learn more.
For more information regarding the walk, please email walk@humanesocietymiami.org or visit www.walkfortheanimalsmiami.com.
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CLASSIFIED ADVERTISING
Members: Up to 7 lines at no charge
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