January/february 2024
A Note From The President Dear Colleagues, I am honored to write my first presidential letter. It is a huge honor and responsibility to lead this great association, and I am very grateful for the opportunity. I am excited about this new 2024 year, and I hope it is filled with many personal and professional successes for each and every one of our members. As times change, our mission is to continue to evolve and keep this association relevant and at the forefront of our community. As we know, our values and morals are constantly being tested and challenged daily in our careers. Nevertheless, our profession still holds a great level of respect and importance in our communities. Even during these challenging times, our profession has grown significantly in the last few years. Nowadays, many large corporations and investors are looking at our profession as an opportunity to grow and invest in us. It is our responsibility to use that opportunity to our advantage and, at the same time, maintain our core values and continue to do what we love. During my time as president, I would like to explore different ideas to make our association more relevant among us and within our communities. Look for ways to give back and increase the level of pride of being a member of the Broward County Veterinary Medical Association. If we can cultivate a level of pride and increase our commitment to this association, there is no doubt that we can do many good things. Please join me in leading this association as we move forward during this time of uncertainty, where everyone is fighting the same challenges alone. As a group, I am sure we can achieve many things we cannot do alone. One of our best opportunities to grow our association is our upcoming pharmacy rules and regulations meeting on February 7 at the Ft Lauderdale Country Club. We all know we can get the required credits online nowadays, but I urge you to attend our meeting in person and start to bring the culture of pride and camaraderie back to our association. You can get the credits online, but the interpersonal skills and relationships we build during our meetings are invaluable and something you will not get online and are a big part of what we are. As we welcome 2024, I hope we can all work together to continue to grow our profession. Know that I am here to serve you as best as I can moving forward and know that I am at your service. Looking forward to a great year! Dr. Armando Villamil,DVM
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October/November 2023
JOIN /RENEW TODAY! Enjoy the camaraderie and top-notch continuing education offered by the BCVMA! We offer 10 great CE meetings per year, including Florida Pharmacy and Rules, a newsletter, and the best Holiday Party in South Florida! Membership is Only $130 yearly. You can join or renew online by visiting https://poynt.godaddy.com/ checkout/afa689cc-149b-4060-8441- 56e98875a44c/2024-membershipor e-mail mreyesnye5115@gmail.com for more information. We look forward to seeing you!
EXECUTIVE BOARD 2023 President Armando Villamil, DVM drv@petcancergroup.com Immediate Past President Stephanie Jones, DVM drstefni@gmail.com Secretary Stefeny Pollack, DVM szpollack@gmail.com Treasurer Claudia Valderrama, DVM claudia67v@aol.com Education Chair Simon Kornberg, DVM drkornberg@sevneurology.com Social Chair Jason Horgan, DVM jason081977@aol.com Newsletter Chair Yolanda Ochoa,DVM dr.yolanda@vet2yourpet.com
Introduction Our patients are living longer! Roughly 50% of our patients are at least 6 years of age and 14.7% are older than 11 years. This is something to be celebrated and with this shift in our patient population, there is a greater obligation on the part of the veterinary healthcare team to advocate for elderly patients. Pet parents may not notice changes in brain aging or may notice them, but not consider them to be relevant enough to report to their veterinarian. In one study, while 75% of pet parents noticed at least one of the signs of cognitive dysfunction in their pet, only 12% had spoken with their veterinarian about it. Another study found that only 7% of owners spontaneously reported geriatric behavior changes to their veterinarian.
When clients are reporting noticed clinical signs to the veterinary healthcare team, too often, the pet parent is dismissed or no treatment is offered. For example, in one study 14% of dogs aged 8 and older are affected with CDS, but only 1.9% are diagnosed. Many may be euthanized prior to diagnosis and treatment.
AGING GRACEFULLY. COGNITIVE DYSFUNCTION UPDATE Lisa Radosta DVM, DACVB Florida Veterinary Behavior Servicewww.flvetbehavior.comwww.drlisaradosta.com @drlisaradosta (Instagram, Facebook, Linkedin).
Key takeaways 1.Pet parents aren’t offering information about behavior changes in senior pets to the veterinary healthcare team. 2.When they do report clinical signs consistent with CDS, diagnosis rate is low. 3.Most pets are euthanized for signs of CDS in 18-24 months after diagnosis. Prevalence and clinical signs The incidence of cognitive dysfunction varies depending on the study cited. Azkona, GarciaBelenguer and Chacon (2009) found that 22.5% of dogs over 9 showed signs of cognitive dysfunction.Neilson, Hart, Cliff and Ruehl (2001) found that 28% of dogs between 11 and 12 years of age reported at least one sign of cognitive dysfunction and 10% had 2 or more signs. In addition, in 15-16 year old dogs, 68% of dogs had at least one sign and 36% had two or more signs of cognitive dysfunction. A good general rule is that signs of CDS are likely to occur in 1/3 of dogs at least at least 11 years old and 2/3 of dogs at least 15 years old. The clinical signs associated with cognitive dysfunction in dogs and cats fall under the same general acronym (DISHAA), however the way that those clinical signs are manifested is unique to the species. The DISHAA acronym stands for: disorientation, interaction changes, sleep/activity changes, breakdown in housetraining and changes in anxiety, activity and aggression (DISHAA) although owners also report apathy, indifference, and less playing. In cats, owners report housesoiling, excessive vocalization, apathy, less play and aggressiveness as the most common signs of CDS..
Key Takeaways 1.One-third of dogs 11 and older and 2/3rdof dogs 15 and older are likely to have signs of CDS. 2.Signs follow the acronym DISHAA in both dogs and cats, but the clinical manifestations of those categories are different. Screening and Diagnosis The communication barrier between pet parent and the veterinary healthcare team can be overcome by using a short questionnaire in the waiting room which can be reviewed by the veterinarian before the appointment begins. Screening should be completed on all dogs over 8 and all cats over 10 years of age. Purina’s questionnaire is easy to use and color coded. Other questionnaires include Canine Dementia Scale (CADES), Canine Cognitive Dysfunction Rating (CCDR) and VISHDAAL (cats). Links are listed at the beginning of this article. The presence of behavioral and physical comorbidities is likely. Pet parents may report behavioral clinical signs consistent with CDS when in fact, they are a result of an underlying systemic condition causing endocrine or metabolic changes and/or pain and discomfort. A full physical assessment is imperative in these cases even if the pet parent believes otherwise. Additionally, it isn’t appropriate nor ethical to assume that a patient has a primary behavior problem without considering the overall wellness of the pet. In addition to physical disease, consider loss of sensory ability such as hearing or eyesight loss. These types of cases can become wormholes as more and more diseases to work up and treatget unearthed. Meanwhile the patient is showing behaviors that frustrate the pet parent who may already be considering euthanasia.CDS is an unprovable diagnosis except post mortem. It is a diagnosis of exclusion and more generally a “good guess” as to what is happening with the pet in many cases. When you see your first true CDS case, you will know! The signs are clear and fit with the DISHAA scale. It is the cases where it isn’t clear, where there are confounding factors and where the pet is ill that can be confusing and frustrating to treat. Key takeaways 1.Screening is necessary in dogs over 8 and cats over 10 years. 2.Use a premade questionnaire to streamline the screening process. 3.Concurrent behavior problems and medical problems are common. Make sure to work each patient up thoroughly. First appointment treatment strategies As mentioned above, by the time that pet parents report changes to their veterinarian, they may have progressed to the point where the pet parent is frustrated and the patient is suffering. Inevitably, it will take time and resources to complete a proper work up on the patient. There is no need to wait to alleviate patient suffering and pet parent stress while labwork is submitted, radiographs or other imaging is completed or pain or nausea trials are started. Strategies for changing the environment and supporting brain health should start immediately. First appointment treatments include nutritional therapy and supplements to support brain health. Canine b/d™ (Hills) diet has an antioxidant package which has been shown to improve age-related behavioral changes and learning ability in older dogs by limiting cellular damage in the brain. This diet can be helpful in prolonging normal cognitive function in older dogs. Owners could see a difference in as little as 30 days.
Nutraceuticals can be helpful in the treatment of cognitive dysfunction. They can be stopped and started without weaning schedules and they generally have low incidence of side effects. They can be used as an adjunct to treatment with medications and behavior modification or they can be used alone. SAM-e has been shown in a double-blinded, placebo controlled study to be effective in alleviating the signs of cognitive dysfunction. SAM-e can be used in cats as well. Senilife® (Ceva) contains phosphatidylserine, pyridoxine, gingko biloba, resveratrol and Vitamin E.In general, the claims for this product include: increased blood flow, neuronal protection, brain metabolism and glucose consumption.In addition, it modulates the dopaminergic and cholinergic system. It has been shown to be effective in the treatment of CDS and can work in dogs and cats within 7 days.
Neurocare™ (Purina) is approved for use as an adjunctive therapy for idiopathic epilepsy, however it has also been shown to improve the clinical signs of CDS in dogs in a double blinded placebo controlled study over three months..
Additionally, at the first appointment, prescribe medications to reduce negative clinical signs immediately. Most behavior medications will not interfere with testing or organic disease. Make choices based on the pet’s clinical signs and also suspected or confirmed disease process. For example, gabapentin use in pets with renal impairment is not recommended without adjusting the dose. Trazodone use is not recommended in patients who have hepatic disease without careful monitoring.Finally, make changes to the environment to eliminate pain and discomfort. For Dogs: 1.Non skid runners or yoga mats to reduce slipping and pain. 2.Change the temperature of the room (some may like it cooler and some warmer), move dog beds into or out of the sun, turn on ceiling fans. 3.Provide ramps to the car, bed, furniture. 4.Move food and water bowls if they are in areas which are difficult for the dog to navigate. For Cats: 1.If there is a change in elimination, change the litterbox size, height of the side of the box, location of the box. 2.Ensure that they have places to hide and rest which are low to the floor and easily accessible. 3.Provide ramps to higher resting places. 4.Move food and water bowls if they are not accessible easily to the cat or if other cats in the household block access. Key Takeaways 1.Start treatment with diet and supplements immediately at the first appointment. 2.Prescribe medications which will do no harm and will not interfere with testing, but will alleviate fear, anxiety and stress. Do not wait to treat. 3.Change the environment so that pets can move around more easily.
Some patients may need treatment with Anipryl® (selegiline, Pfizer), a selective MAO-B inhibitor (when administered as directed), is FDA approved for use in canine cognitive dysfunction. It can restore the sleep/wake cycle and help to slow the progression of cognitive dysfunction. It inhibits the reuptake of dopamine, norepinephrine and serotonin, increases free radical elimination and alters dopamine function. Because of its broad scope of action, it interacts with multiple drugs which are commonly used in veterinary medicine. Medications which should not be combined with selegiline include medications which affect the reuptake of serotonin and dopamine on any level and other MAO inhibitors. Read the drug monograph for selegiline and any other medications prescribed concurrently before instituting polytherapy. Selective serotonin reuptake inhibitors (SSRIs) can be used to treat the anxiety and aggression which may accompany cognitive dysfunction. In general, SSRIs have fewer side effects than selegiline, but monitoring is still necessary in older pets. Key Takeaways As dogs and cats live longer, the likelihood of age related behavior problems increases. With treatment of underlying medical problems and behavioral problems, the quality of life of our geriatric canine friends can be improved tremendously.
Follow up appointments and ongoing treatment The long-term plan for CDS patients will most likely include many medication changes or at least tweaks. CDS is a progressive disease that we can slow, but not stop entirely. If the pet is truly affected, they will get worse with time. One of the best ways to ensure success is to check in with the pet parent regularly. If this isn’t done, you will often find yourself running from crisis to crisis which is never desirable for patient management.Referral to a board-certified veterinary behaviorist may be necessary. Working with a qualified positive reinforcement dog trainer may also be of benefit. Enrichment and exercise can help to reduce and potentially reverse some signs of CDS. Adding these elements to treatment can affect very positive changes. Pet parents should be aware that any dog, even those who have not shown aggression can get irritable in their old age. They may never expect that their dog will bite and may feel guilt, anger and shock if their dog shows aggression. It is better to warn pet parents of the likelihood than to manage the crisis when it happens. Additionally, other pets in the household may be confused by the changes in the older pet’s behavior. Cats and dogs communicate a great deal through body language. If the older pet is unable to respond because they cannot see those subtle signs of stress or conflict, fights may occur. Warn the pet parent of this possibility and take precautions to protect all involved, especially the older pet. One of the best guidelines for treatment of CDS and all behavior problems for that matter are the five freedoms.
2024 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, March 15, 2024 Please contact Linda Tinsley with any questions: linda.tinsley@myfloridalicense.com
Up Coming CE Meetings "Florida Pharmacy Rules and Laws" February 7, 2024 Ft. Lauderdale Country Club RSVP Today
Dr. James Anderson II` 954-347-3557 doctor_anderson98@gmail.com Dr. Peggy Carlow 954-341-9552 pmcarlow@att.net Dr. Ursula Dell 965-696-0642 drdell03@gmail.com Dr. Diana Drogan 954-854-9426 dr.diana.dvm@gmail.com Dr. Fumiko Miyamoto 352-339-2207 www.theasiandoctorllc.com Dr. Tolulope Ogunyemi302-464-8387 reliefvet4@yahoo.com Dr. Cindy Rigg 305-968-8345 csrigg@yahoo.com Dr. Dan Selvin 954-604-0084 dcselv4@gmail.com Dr. Mark Steele 954-942-7193 mdsteele@bellsouth.net Dr. Ana M. Tassino 305-335-3111 tassino@bellsouth.net Dr. Claudia Valderrama305-297-8893 claudia67v@aol.com Dr. Stephen Waldman 561-214-3306 swaldman85@comcast.net
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This newsletter is published bi-monthly by the Broward County Veterinary Medical Association, Inc., 200 NE 12th Avenue Apt 8 B Hallandale, Fl 33009. Editorial Guidelines: Letters and articles are welcome. All submissions must be signed and the author's name will be published. Entries must be received 14 days prior to the publication date. Display Ads: Please e-mail all submissions to mreyesnye5115@gmail.com. The Views and opinions expressed herein are not necessarily those of the officers of the BCVMA or it's representatives. Products and services advertised herein are not necessarily endorsed. Membership Cost: $130.00 per year. Includes all CE meetings and invitation to all social events. Pay online : https://poynt.godaddy.com/checkout/afa689cc-149b-4060-8441-56e98875a44c/2023-membership
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