Surgical Approach to Pituitary Disease - c.ymcdn.com · Surgical Approach to . Pituitary Disease. magazine of the . NEW YORK STATE VETERINARY MEDICAL SOCIETY. ISSN 2333-3375 ... Anatomy

IN THIS ISSUE: Compounding Legislation And More …Health Hackathon

magazine of the NEW YORK STATE VETERINARY MEDICAL SOCIETY

issue 17.02| Mar.-Apr.

Surgical Approach to

Pituitary Disease

magazine of the NEW YORK STATE VETERINARY MEDICAL SOCIETY

ISSN 2333-3375 • USPS 407-350100 Great Oaks Blvd., Suite 127, Albany NY 12203

Tel. (800) 876-9867 • Fax (518) 869-7868 • Email [email protected] • Web www.nysvms.org

Connections is published bimonthly by the New York State Veterinary Medical Society Inc., 100 Great Oaks Blvd., Suite 127, Albany NY 12203. Subscriptions are $1/year to members as part of their annual dues, $25/year to subscribers and $50/year to nonmember veterinarians in New York State. Opinions expressed in articles and editorials of Connections are those of the authors and are not necessarily those of the New York State Veterinary Medical Society Inc. Second-class postage paid at Albany, N.Y.

Postmaster: Send address changes to: NYSVMS, 100 Great Oaks Blvd., Suite 127, Albany NY 12203.

issue 17.02 | Mar.-Apr. 2017

Executive DirectorJennifer J. Mauer, CAE

Communications SpecialistStephanie Quirini

Education/Conference SpecialistDory Fisk, CMP

NYSVMS OFFICERSPresident

Margret “Meg” S. Thompson, DVM, DACVR

President-electSurinder Wadyal, DVM

Past PresidentSusan Wylegala, DVM

TreasurerAllan P. Bregman, DVM

AVMA DelegateWalter K. McCarthy, DVM

AMVA Alternate Delegate Eric Bregman, VMD

REGIONAL OFFICERSCapital DistrictMark E. Will, DVM

Catskill MountainDavid C. Leahy, DVM

Central New York Victoria Bentley, DVM

Finger LakesRobert Hamilton, DVM

Genesee ValleyCharles A. Fleming, DVM

Hudson ValleyJoseph D’Abbraccio, DVM

Long IslandRobin Sturtz, DVM

New York CityAllan P. Bregman, DVM

Northern New YorkJessica Scillieri Smith, DVM

Southern TierTBD

Westchester/RocklandPaul Amerling, DVM

Western New YorkJeanne E. Best, DVM

2 March-April 2017

Legal/Legislative Counsel Alexander Betke, Esq. Frank Fanshawe, Esq.

Jackson Lewis P.C.

Membership Assistant Jennifer Hill

Bookkeeper Brenda Schermerhorn

TABLE OF CONTENTS DEPARTMENTS

5 Executive Director’s Message

7 Legal

17 In Memoriam

18 Classified Ads

INDUSTRY

14 Kinesiology Taping for Dogs

16 Cornell Hosts Animal

Health Hackathon

ASSOCIATION

17 NYSVMS Agriculture

Awareness Grant Program

page 10Surgical Approach to Pituitary Disease

4 March-April 2017

Hall of veterinary healthVOLUNTEER AT THE

AT THE GREAT NYS FAIR!

NYSVMS will once again host the Hall of Veterinary Health at the Great NYS Fair in Syracuse, promoting veterinary medicine to the public in a fun, hands-on way.

Volunteers are needed to staff the Hall each day. Several new interactive exhibits were added last year including Comparative Anatomy featuring real animal skulls, Dress Like a Surgeon, Teddy Bear ER, Journey Through Imaging, Preparing your Pet for a Vet Visit and Building your own Stethoscope!

The Hall also features daily live presentations with animals ranging from reptiles to birds to mini ponies as well as daily first aid demonstrations.

Volunteers receive two complimentary admission passes and one parking pass. If you are interested in volunteering, please send your name, address, email, phone number and the date(s) you would like to volunteer to [email protected].

Check out the Hall of Veterinary Health section on our website: www.nysvms.org which includes a video of highlights from last year’s event.

Photos by: Photography With TLC

WWW.NYSVMS.ORG

March-April 2017 5

Executive Director’s Message

Jennifer Mauer, CAEExecutive Director

NYSVMS UPDATE

“The people doing the work are the moving force behind the MacIntosh. My job is to create a space for them, to clear out the rest of the organization and keep it at bay.” Steve Jobs

A few weeks ago I found this quote on my son’s “Famous Quotes” page-a-day calendar. I saved it, thinking it would make a great opener to the 2017 Year in Review article I planned to write in November, summarizing the amazing achievements made by the staff, volunteers, and members of the association. But alas I find I’m referencing it sooner than I planned – as a final message to say goodbye as your Executive Director. But I like to think it of more as a “see you soon” message, since I plan to stay engaged in the veterinary profession.

Yes it’s true, I will be departing this summer as your Executive Director. In the words of the Grateful Dead, “what a long, strange trip it’s been” and I LOVED every single minute of my time at NYSVMS!

Most of you were not aware that, for the past two years, I have been commuting between Reno, N.V. and Albany, N.Y. so

my teenage son can attend school out west. While he’s enjoyed a very rewarding educational career, it became apparent that my husband and I needed to direct our focus on being full-time parents, in the same time zone, as we navigate him into adulthood. This decision wasn’t easy, as I have found my job at NYSVMS to be the single most rewarding opportunity of my career. However, family will always come first, as it must in this case.

“We keep moving forward, opening new doors, and doing new things, because we’re curious and curiosity keeps leading us down new paths.” Walt Disney

It’s been my honor to serve the Society, and I hope I’ve served you well. I’m humbled by the energy, enthusiasm and intelligence surrounding the veterinary profession and all of you within it. As veterinary professionals, you challenged me to see situations in a different light, to question issues that needed to be corrected, and to feed my insatiable curiosity about how NYSVMS could make your veterinary lives a bit better.

Hopefully our paths will cross again, as I’m not leaving the profession entirely. I’m putting my business development talents to work for my husband’s new start-up, VetCompanion. In that role I will be exhibiting at the veterinary conferences, including the AVMA’s annual conference this summer. If you find yourself passing through Indianapolis, stop by and say hello!

“Someone is sitting in the shade today because someone planted a tree a long time ago.” Warren Buffett

A national search for my successor has been underway for several weeks. As of this writing I’m confident they will find an exceptional leader to continue moving the NYSVMS forward. I have committed to insuring I will train, guide and support the next Executive Director so the association can thrive through a seamless transition. Hopefully my successor will benefit from trees planted these last few years, which will allow them to cultivate the vast quantity of ideas and new initiatives identified in the Executive Board’s Strategic Plan.

I believe in NYSVMS all the way – always have, and always will. I hope I’ve instilled this in the members who support us. You make it easy to strive to be the best in all we do. Your dues investment in NYSVMS, your support of your elected leaders, and your commitment to organized veterinary medicine provides us the resources needed to solve problems affecting the profession. While serving you is our business, it is also our pleasure. Thank you for continuing to be a member of NYSVMS.

“I can no other answer make than THANKS, and thanks, and ever thanks….!” William Shakespeare’s Twelfth Night, Act III, Scene 3

Steve Jobs was right about many things, but on this he was spot on – my job is to pave the way for really great people to achieve some outstanding things for the Society. Thank you to the volunteers, at the state and local levels, who gave up their free time to serve the profession. Without you, NYSVMS would not be where it is today. Thank you to the Jackson Lewis team, who work tirelessly day

and night to make sure laws and legal pitfalls are maneuvered and addressed, resulting in protection of your profession from unwanted intrusion and liability.

Thank you to the many organizations, state agencies and legislators who built collaborative relationships with NYSVMS. We will continue to forge ways to work together on issues of common ground. Our leadership team is committed to working with you wherever we can.

And the same can be said for the network of industry sponsors, vendors and affinity partners of NYSVMS. While you do lend considerable support financially, you also bring volumes of knowledge and ideas that help develop new products and services for members. Thank you for your support!

Thank you to the Executive Board, past presidents, and our extensive network of regional VMA leaders. Your guidance, engagement and energy level never wavered. NYSVMS is in great hands because of your leadership and dedication.

And most of all, THANK YOU to the staff that worked alongside me. You have shown exemplary leadership, unwavering dedication to the task, and have worked behind the scenes, many nights and weekends, in order to bring a project to its successful fruition. An executive director is nothing without an amazing staff. You kept me honest, you kept me challenged, and most of all, you kept me inspired. Keep up the great work!

So, on that note, I’ll close with “see y’all later” ! In the words of Jimmy Durante……Goodnight Mrs. Calabash…..wherever you are!

Jennifer Mauer, CAE Executive Director

6 March-April 20176

Forward booking simply means scheduling ALL patients’ next appointments before they leave the practice after their current visit. This should be done for medical progress exams and for preventive healthcare exams. Forward booking ensures your patients receive the highest quality care at the right time.

Partners for Healthy Pets has designed a suite of tools to help you implement forward booking in your practice. When you put all of these forward booking pieces together, the result is healthier patients and a healthier practice.

Where to start: Go to www.partnersforhealthypets.org and click on the Forward Booking tab on the top of the homepage. There you can access all forward booking tools online which are also available in a downloadable format.

Declare your practice a Forward Booking Practice at a staff meeting and identify a champion for this project. To be successful, the entire practice team needs to understand the value and benefi t of this important initiative.

Train your team and develop a practice protocol for forward

booking with staff input. Use the how-to guide, Forward Booking Appointments: How to Fill Your Appointment Schedule, the communication tips training video and the video discussion guide. Everyone needs to commit to make this happen.

Keep forward booking top of mind for your team and clients with posters and buttons. Buttons can be ordered and a PDF of the posters can be downloaded at the website.

For a more comprehensive approach to forward booking, you can use the forward booking module in The Preventive Pet Healthcare Practice Champion Workbook. You can order the workbook at the Veterinary Hospital Managers Association website or the National Association of Veterinary Technicians in America website.

THE KEY TO FORWARD BOOKING APPOINTMENTS:

Unlock the Potential of a Best Practice for Your Practice

access all forward booking tools online which are also available in a downloadable format.

Karen E. Felsted, CPA, MS, DVM, CVPM, CVA

Karyn Gavzer, MBA, CVPM

Forward Booking Appointments:

How to Fill Your

Appointment Schedule



Appointments:

How to Fill Your


The development of this workbook was supported by a grant from Partners for Healthy Pets.

PREVENTIVE

PET HEALTHCARE

Your guide to becoming a

PRACTICE CHAMPION

4

1

2

3

5

Forward booking simply means scheduling ALL patients’ next appointments before they leave the practice after their current visit. This should be done for medical progress exams and for preventive healthcare exams. Forward booking ensures your patients receive the highest quality care at the right time.

Partners for Healthy Pets has designed a suite of tools to help you implement forward booking in your practice. When you put all of these forward booking pieces together, the result is healthier patients and a healthier practice.

Where to start: Go to www.partnersforhealthypets.org and click on the Forward Booking tab on the top of the homepage. There you can access all forward booking tools online which are also available in a downloadable format.

Declare your practice a Forward Booking Practice at a staff meeting and identify a champion for this project. To be successful, the entire practice team needs to understand the value and benefi t of this important initiative.

Train your team and develop a practice protocol for forward

booking with staff input. Use the how-to guide, Forward Booking Appointments: How to Fill Your Appointment Schedule, the communication tips training video and the video discussion guide. Everyone needs to commit to make this happen.

Keep forward booking top of mind for your team and clients with posters and buttons. Buttons can be ordered and a PDF of the posters can be downloaded at the website.

For a more comprehensive approach to forward booking, you can use the forward booking module in The Preventive Pet Healthcare Practice Champion Workbook. You can order the workbook at the Veterinary Hospital Managers Association website or the National Association of Veterinary Technicians in America website.

THE KEY TO FORWARD BOOKING APPOINTMENTS:

Unlock the Potential of a Best Practice for Your Practice

access all forward booking tools online which are also available in a downloadable format.



Forward Booking Appointments:

How to Fill Your




Appointments:

How to Fill Your


The development of this workbook was supported by a grant from Partners for Healthy Pets.

PREVENTIVE

PET HEALTHCARE

Your guide to becoming a

PRACTICE CHAMPION

4

1

2

3

5

March-April 2017 7

LEGALAre You the Mother? And Other

Ownership Quandaries

O wnership is the foundation of every veterinarian-patient relationship.

Except for very few enumerated exceptions, owner consent is required to treat an animal, release medical records to a third-party, euthanize an animal, or dispose of animal remains. In fact, most obligations hinge on ownership, and therein lies the quandary – who owns the pet?

Are You the Mother?Many animal owners likely self-identify themselves as pet parents. However, unlike a child, who has a birth certificate, an adoption certificate or other court document that can readily

verify guardianship and decision making authority; identifying an animal’s owner can be more difficult. The transient nature of animals, and their inability to verbally communicate, can conflate the issue of ownership identification.

Long thought to be mere property, the legal system is slowly adapting to the idea that animal companions, especially dogs, are members of the family, not just chattel. This shifting vision means pet ownership is more often subject to court review. Despite this shifting view and the increasing court cases awarding pet custody, the law still identifies pet guardians as owners rather than parents. For instance, New York requires all

dogs over four months in age to be licensed, which in turn creates an identifiable legal owner of record for each dog residing in the municipality. The license must be renewed each year, and any changes in ownership or loss or suspected theft of a dog must be reported to the licensing municipality within ten (10) days of such event.

Proving Ownership, What is Enough?To license a dog, the person must provide the municipality proof of ownership, which often includes proof of rabies vaccination and a veterinary bill. Oftentimes resulting in the veterinarian making an independent ownership assessment.

Ownership equates property rights in the animal, which allows for ownership of the animal to be passed from one person to another. While a veterinarian is not expected to investigate or resolve ownership disputes over an animal, best practice is to request copies of registration information, adoption papers, proof of purchase, microchip information and prior veterinarian records at the initial visit. In addition, a veterinarian should scan the animal for a microchip. Scanning an animal, who is not wearing identification tags, is often the quickest way to confirm ownership or reunite a lost or stolen animal with its owners.

Are you Co-Parenting?Veterinarians can find themselves caught in the middle of feuding individuals. This is why it is important to name only one owner at the time of the initial onboarding of an animal to the practice. Any other person listed on the medical record should

be indicated to be agents who have permission to consent to treatment of the animal—a right that can be revoked at any time by the owner of the animal. This practice may help to alleviate the veterinarian being asked to arbitrate pet, co-parents disputes, leaving this decision to the courts where it belongs.

A veterinarian is not obligated to determine the ownership rights of the animal, although he or she may be called into court as a witness for that very purpose. Pet custody and ownership issues are on the rise in marital dissolution cases, where judges are more frequently being called to arbitrate and determine animal ownership rights. Recently, some courts have applied a best interest of the animal standard, akin to that of a child custody determination. Included in this analysis is a query into each party’s ability to care for the dog, including taking the animal for veterinarian care. As a veterinarian you may be subpoenaed to testify or produce records at a trial. This means that moving forward, animal patients’ records may very well include a court order declaring ownership and decision making authority.

Is the Animal Lost or Abandoned?If an unknown animal is brought to a veterinarian, the veterinarian should scan the animal for a microchip and look for any other identifying tags, such as a license or rabies tag. If the dog is wearing a license tag, the issuing municipality should be contacted so that the dog’s owner can be alerted. Once an owner has been notified by animal control of their dog’s location, the owner is given up to nine (9) days to retrieve the

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dog if notified of its recovery by mail (or seven (7) days if notified personally) before the dog can be put up for adoption or euthanized.

If the animal is not microchipped, and is not wearing tags, the veterinarian should recommend that the animal be turned over to an animal shelter to facilitate efforts to locate the animal’s owner. The lost animal will be held by the shelter for a period of five (5) days prior to adoption or euthanasia. Oftentimes, animal shelters are at capacity and may be unwilling to take in stray animals. If this is the case, the veterinarian can recommend other rescue groups in the area who may be able to help care for the animal and reunite it with its owners.

In the event an animal’s owner cannot be located, another person may choose to claim ownership once the above timeframes have lapsed, and the aforementioned efforts have been made to locate the animal’s prior owner. There

may also be circumstances where an owner relinquishes rights to the animal prior to the expiration of these timelines.

It is important to note, however, that animals are property, and a person choosing to claim possession and ownership of a lost or stolen animal must do so at their own risk of future liability or legal proceedings by the prior owner.

Is There Going to be Continuity of Care?If an owner becomes ill or passes away the beloved pet’s needs and care may be left in limbo. Thus, a veterinarian may want to ask his or her clients whether they have considered having a Power of Attorney in place to ensure continuity of care should the owner become unable to render these decisions. Whether presented with a Power of Attorney, or discussing its usefulness with clients, there are a few key items to keep in mind.

New York Law now requires that a Power of Attorney specify the powers granted, and provides for a statutory short form. While it is sufficient to grant authority to act for “chattel and goods transactions,” it may be prudent to delineate specific powers for the care of the client’s pet(s) under the “all other matters” portion. Further, when reviewing a Power of Attorney form it is imperative to ensure there are no enumerated modifications limiting the agent’s ability to act. For instance, a limitation on the ability of the agent to authorize euthanasia or disposal of the pet.

Creation of pet trusts are also gaining traction. Advising a client to consult with a lawyer to ensure continuity of care is a best practice. Proper legal documentation will be beneficial for all involved. It will allow the veterinarian to have proper legal support to continue any agreed to treatments, the client will gain piece of mind, and the animal’s health and

well-being will be protected. It is important to verify that the person purporting to act on behalf of the animal’s owner has been granted authority. In order to do so, ask to see a copy of the Power of Attorney, or other document purporting to confer ownership, and keep a copy in your file.

TakeawaysAsk questions when onboarding an animal patient to verify ownership and request copies of all documents evidencing the purchase or adoption of the animal for your records. Scan the animal for a microchip or any other identifying tags. Identify only one person as the owner on the medical records to avoid disputes and confusion in the future. If additional individuals will be caring for the animal, request written consent to permit these additional individuals to act as agents for the owner.•Caitlin Donovan, Esq. Jackson Lewis, P.C. Albany, NY

March-April 2017 9

LEGALNYSVMS Compounding Legislation

A s a member of NYSVMS, your dues dollars are being wisely invested to advance our

legislative agenda. The primary focus of the NYSVMS legislative effort is the enactment of legislation relating to the compounding, dispensing, and sale of pharmaceuticals by doctors of veterinary medicine. Throughout 2016, members of NYSVMS worked to educate legislators on the role of and issues pertaining to compounding in veterinary medicine, as well as on a workable bill draft that could be introduced in both houses of

the legislature to help address the current challenges faced by veterinarians. This culminated, in spring 2016, with legislation sponsored in the Assembly by Assemblyman Ken Zebrowski (D – Rockland County) and in the Senate by Senator David Valesky (D – Madison, Oneida, and Onondaga Counties).

Over the course of the summer and fall months, NYSVMS members and legislative counsel met with and spoke to the sponsors of the legislation to continue answering questions and providing additional information on the issue. This included providing

literature and facts about the compounding process to legislators, and reinforcing the importance of compounded medications in the treatment of animals. At the outset of the 2017 legislative session, both sponsors reached out to legislative counsel to indicate that they were still interested in carrying the legislation in the new session, and on working toward passage of the bill in both houses of the legislature.

In late January and early February 2017, respectively, Assemblyman Zebrowski and Senator Valesky reintroduced the compounding legislation. The new bill numbers, as referenced in the legislative agenda, are A.3440 (Zebrowski) and S.4360 (Valesky). This legislation would amend the New York State Education Law to permit a pharmacist to dispense drugs, including veterinary-specific compounding medications, to a veterinarian. Further, it would allow a veterinarian to possess and keep in stock those medications for administration and sale pursuant to a non-patient specific regimen prescribed or ordered by a licensed practitioner of veterinary medicine.

Federal regulations prohibit veterinarians from obtaining medications from pharmacists for office use because a compounding pharmacy can

compound medications only for specific patients. As a result, veterinarians treating patients on an emergent basis do not have compounded medication on hand in their office, and a time lag exists between when the medication is compounded and when it is ultimately delivered to the patient. Animals needing compounded medication continue to suffer while waiting for the medication to be available to them, but the goal of this legislation is to allow veterinarians to have compounded medications available in the office for immediate use and administration, eliminating the wait.

The bill has been referred to the Higher Education Committee in both houses, which has jurisdiction over legislation amending parts of the Education Law dealing with licensed professions. The ultimate goal of NYSVMS as it pertains to the compounding legislation is to move this bill through the committee process in the Assembly and Senate, and then through each house for a vote during the 2017 legislative session. Once the bill has been voted on in both houses, it will be sent to the Governor for his signature or veto. •

Emily Whalen, Esq. Jackson Lewis, P.C. Albany, NY

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FEATURE

Pituitary Surgery in Dogs and Cats

H yperadrenocorticism (HAC) in dogs is well known to veterinary practitioners as it is one of the most

prevalent endocrinopathies that we treat. Canine HAC is estimated

to affect 1-2 dogs/1000 cases/year. In 85% of cases, the cause is secondary to autonomous secretion by functional ACTH secreting neoplastic cells within the pituitary gland; i.e. pituitary dependent

hyperadrenocorticism (PDH). At the time of diagnosis, as many as 30% of dogs with this diagnosis will have macro-tumors, meaning they extend outside of the margins of the normal gland. Up to 75% demonstrate

growth within the first 12 months from diagnosis regardless of whether these tumors were micro or macroscopic.

Currently, there is no medical therapy to slow or prevent

Patient positioning for transoral hypophysectomy using high definition exoscope to visual the soft palate and surgical corridor. Note the wide field of view.

March-April 2017 11

growth proliferation of these cells in dogs.

Imaging studies have shown that pituitary masses in dogs with PDH actually increase in size throughout the course of therapy. The cause is believed to be the loss of negative feedback with selective inhibition of cortisol secretion at the level of the adrenal glands - thus, the likely conclusion is that therapy with Mitotane or Trilostane may actually stimulate pituitary tumor expansion.

With the growing availability of CT and MRI to better visualize the area of the pituitary gland, our understanding of the progression of symptoms with PDH and options for guided therapy are now expanding. Both surgical and radiation therapy have become more widely available and represent the best options for dealing with the neurological manifestations of pituitary macro-tumors. However, radiation does not appear to adequately address the functional nature of ACTH secreting tumors with the majority of dogs requiring continued medical management. Surgical removal of the pituitary remains the most definitive means of controlling both the clinical syndrome and mass effect. The role and timing of surgical intervention in this disease and other tumors of the pituitary fossa have yet to be established in veterinary medicine.

Surgical management of diseases in the area of the pituitary has been a long-time challenge to modern neurosurgery. The pituitary gland lies within a depression of the sphenoid bone (the sella turcica) connected to the hypothalamus via a thin stalk of tissue (the infundibulum). The sphenoid bone comprises the rostal portion of the base of the skull. Further complicating this anatomy are intricate vascular and neural passages surrounding the pituitary fossa. The arterial

circle supplying the majority of the brain encircles the bony margins of the sella turcica within the skull. Laterally, the borders of the fossa are defined by large venous sinuses containing the 3rd and 4th cranial nerves as well as branches of the trigeminal nerve and internal carotid artery. Surgical access to the sella turcica and area dorsal to the sella – the suprasellar space – is complicated by these vital structures.

As masses grow into the suprasellar region, they cause compression of the hypothalamus and the rest of the diencephalon. Clinical signs are varied and can be indistinguishable from signs of hypercortisolism and trilosane/mitotane side effects. Lethargy, anorexia, stupor and tetraparesis with low head carriage are most common. Behavioral changes, ataxia and circling are also noted. Blindness is not a common manifestation, despite the proximity of the optic chiasm. Seizure has been reported but it is not clear if this is related to the tumor or a factor related to PDH. Very rarely, infarction or hemorrhage into a pituitary mass may occur resulting in severe, peracute neurologic signs—a condition known as

pituitary apoplexy. The condition is recognized in humans and dogs. In dogs, it can result in peracute mental depression, behavioral changes, visual disturbance and gait alterations. Diagnosis requires MRI or CT, timely intensive care and possible surgical decompression. Fortunately this condition is rare.

Investigations utilizing the surgical management of pituitary-related disease in the dog have been practiced since the late 1800’s, when the first transcranial approaches to the canine pituitary fossa were described. These techniques have paved the way for the surgical management of structural disease of the pituitary fossa in humans. The eponymous Dr. Harvey Cushing, for whom the syndrome of hypercortisolism is named, popularized a trans-sphenoidal approach in early monographs from 1912. Today, selective adenectomy via an endonasal transsphenoidal approach is the standard of care for pituitary dependent hyperadrenocorticism in humans. The surgical approach via the nasal passages is attractive, as it leaves patients without a visible surgical incision and greatly reduces both morbidity and

pain. This approach has been expanded to involve diseases of the entire base of the skull - from the ventral olfactory area to the atlanto-axial articulation. Due to differences in nasal and skull base anatomy, the modern canine and feline equivalent involves a trans-oral, nasopharygeal approach via an incision in the soft palate. While this allows only a narrow surgical corridor, the pituitary and tumors of this area can be successfully removed without significant morbidity. Despite the first successful report of hypophysectomy for the treatment of hyperadrenocorticism in dogs as early as 1968, the procedure has failed to gain popularity within the veterinary community. Pioneering work was undertaken by Meij et al in the Netherlands in the 1990’s to standardize the approach, however it has gained common use within the past decade in only a few centers in Japan, the United Kingdom and only recently in the USA.

Detailed anatomical studies with MRI are ideal for visualization of tumors and surgical planning. This is especially important when considering surgery for nonfunctional tumors of

Intraoperative view of exposed pituitary gland in a cat. The soft palate and nasopharyngeal mucosa are incised and retracted. The sphenoid bone ventral to the sella turcica has been removed exposing the pituitary gland. This pituitary is normal in size for this patient.

12 March-April 2017

the pituitary fossa. Pituitary masses can be broadly classified as functional or nonfunctional. These can have a benign behavior as with hyperplasic, adenomatous or cystic lesions. Malignant biologic and histopathologic behavior is also possible, as with adenocarcinoma or carcinoma. MRI may be useful

in helping to predict histologic subtype and identify secondary changes in the brain. CT scans may be sufficient in many cases and can be used for detailed surgical planning or to supplement MRI findings.

Surgical TechniqueBoth trans-oral and a ventral paramedian approach to the pituitary fossa have been described. The author prefers the trans-oral approach, as this involves less tissue dissection, and removal of diseased tissue is aided by gravity, as the patient is positioned in sternal recumbency with the mouth open. A midline incision is made in the soft palate and the nasopharyngeal mucosa. Access to the sella turcica is obtained using a mechanical burr. The

dura mater overlying the tumor is incised to allow visualization of the mass. In most cases, tumor cannot be distinguished from normal pituitary, therefore the entire hypophysis is extracted until the ventral hypothalamus and third ventricle are observed. Unlike the case in humans, well defined pituitary adenomas are rare therefore surgical

management in dogs and cats necessitates extirpation of the entire gland with resulting hormone deficiencies.

Postoperatively, patients require close monitoring in an intensive care unit. Due to removal of the pituitary gland, patients require lifelong thyroid and cortisol supplementation. Diabetes insipidus is also a concern although this is transient in the majority of patients. A transient decrease in tear production is also common following surgery but may be permanent. Growth hormone deficiency does not appear to be a factor after hypophysectomy with levels returning to normal within weeks of surgery.

Long term outcome data is known for 180 patients treated by hypophysectomy for PDH by investigators at Utrecht University in the Netherlands. Remission was maintained in 75% of dogs with 79% still alive four years after surgery. Overall mortality was less than 10%. Prolonged diabetes insipidus was 21%, requiring long term

desmopressin administration. These results compare favorably to results of medical management with Trilostane and Mitotane, where survival data is similar between both drugs. Median survival has ranged from 700-900 days, however survival rates are lower with only 71% and 54% alive at 1 and 2 years, respectively. In one study of the chronic use of Trilostane, approximately 50% of patients euthanized due to persisting signs of hypercortisolism had neurologic signs at the time of death. A high incidence of side-effects and relapse also complicate medical management.

Considering the invasive nature of tumors within the pituitary

gland it is unclear if selective hypophysectomy will be possible for dogs and cats which is different from the case in people. Veterinarians should be aware that disruption of adrenal, thyroid, and gonadal hormonal axes are permanent requiring lifelong supplementation, and that diabetes insipidus remains an uncommon, transient but potentially persistent complication.

Prognostic Factors Of HypophysectomyIt is important to note that approximately half the dogs reported in the large Utrecht study did not have macrotumors. Size of the pituitary tumor at the time of surgery appears to be an important prognostic indicator. Dogs with larger tumors appear to have a greater incidence of relapse and decreased survival.

Since the initial descriptions of this surgical approach in dogs and cats, technological advances have been added. Previously, surgical loupes were advocated considering the narrow surgical corridor and delicate anatomy visualization is paramount. Surgical microscopy and most recently a video exoscope (VITOM, Storz instruments) has been utilized to improve visualization. The scope looks like an endoscope but with a longer focal distance, hence it is positioned up to 25cm outside of the surgical field allowing instruments to be passed easily without hindering vision. The wide field of view and greatly magnified surgical field is projected on a high definition viewing screen opposite the surgeon. Video optic technology allows digital enhancement to highlight anatomical details. Greater visualization has direct effects on outcome. This is noted in one report featuring use of an exoscope for hypohysectomy. Results in this cohort of 26 dogs showed similar survival data to the larger study by Hanson et

“With the growing availability of CT and MRI to better visualize the area of the pituitary gland, our understanding of the progression of symptoms with PDH and options for guided therapy are now expanding. Both surgical and radiation therapy have become more widely available and represent the best options for dealing with the neurological manifestations of pituitary macro-tumors.”

March-April 2017 13 13

al (Utrecht, the Netherlands), however in the study by Mamelak et al median tumor volume was 9 times that of the dogs in the Utrecht study. Of note the incidence of long term diabetes incipidus was also reduced to 9.5% in this prospective study. Further improvements in surgical planning and technique are currently being employed at several institutions. Use of real-time neuronavigation technology, allowing accurate identification and tracking of surgical instruments during surgery has facilitated locating tumors while avoiding critical structures. Use of specialized suction and ablative devices has also improved removal of abnormal tissue avoiding excessive surgical manipulation. The use of high-field MRI coupled with neuronavigation systems provide better surgical planning and execution, while improved visualization and surgical

Neuronavigation planning software highlighting location of the pituitary gland using a frameless stereotactic system. MRI was used for planning. This provides real time navigation at surgery to guide the surgical approach. The crosshair is centered on the pituitary gland of this feline patient.

instrumentation provide for more effective removal of larger and more complicated masses.

What About Cats?In comparison to dogs, the incidence of PDH in cats is relatively uncommon. Cats show a greater diversity with pituitary adenomatous disease in that growth hormone secreting tumors are more common in this species. In addition to the ill effects of the primary endocrinopathy and neurologic deficits manifesting from mass effect of these tumors, the clinical picture in cats is more often complicated by concurrent diabetes mellitus. Diabetic control is often a major challenge due to insulin resistance from either cortisol or growth hormone effects. Medical therapy is often complex and incomplete rendering the long term prognosis guarded with these diseases in cats.

Radiation therapy has been successful in ameliorating neurologic signs but complicated diabetic management remains despite the positive effects on the mass lesion. While there are few cases in the veterinary literature transsphenoidal hypophysectomy appears to be a successful modality. Cats follow a similar post-operative course to dogs with the benefit of resolution or greatly enhanced and manageable control of diabetes mellitus. Thus, transsphenoidal hypophysectomy may soon become the treatment of choice in this patient population.

ConclusionThe growth in availability of CT and MRI coupled with experience with surgery of the pituitary fossa will affect the diagnosis and management of dogs and cats with pituitary dysfunction in the near future. Advanced

imaging with CT or MRI may come to play a role in staging dogs with PDH. Serial imaging and advanced techniques would help identify patients with progressive disease, allowing better selection of patients that would benefit from surgery and prediction of outcome. Although less common, the neurosurgical procedures employed in transsphenoidal hypophysectomy may be used to surgically address a multitude of structural lesions of the suprasellar region. In time, this may be expanded to include the entire skull base; an area heretofore considered inaccessible. •

John McCue, DVM, DACVIM (SAIM, Neurology) Staff Doctor, Animal Medical Center, N.Y.

All images courtesy of Animal Medical Center-NY.

14 March-April 2017

INDUSTRY

Kinesiology Taping for Dogs

I f you watched the Rio Olympics last summer, you may have noticed athletes wearing colorful tape along their

arms, legs, and even torso. If you looked carefully, you may have even seen it on some of the event horses. What is that stuff, you ask? It’s kinesiology tape. This may seem like a new thing, but in fact it’s actually just gaining in popularity.

It was developed in Japan in 1979 and has been used in both people and horses since then. There has been varying success with different tape on animals, mostly because of their hair coat and activity. I had used it on myself and had seen the benefit, but couldn’t find a brand that worked on my furry patients.

I started working with RockTape last year and have been very impressed with it. This tape actually sticks extremely well to dogs and stays on for a number of days. As I started to work with it more and more, I found myself using it on different conditions. I also got great feedback from clients and my technicians on patient improvement and ease of use.

I would like to share that knowledge with you and give you some background so that you can use it on pets. Let’s start with what it actually is. Then we can discuss what it is not, and finally how we use it safely in veterinary medicine.

It’s a cotton weave tape that has 180% elongation from its original length. The tight weave provides more durability for the tape in our patients. The non-latex acrylic adhesive is

very sturdy. The adhesive is heat activated (just by rubbing your hands on it), and I have yet to need an additional adhesive spray to keep it on my patients. RockTape is waterproof, as is evident by my dog Penny wearing it in the underwater treadmill.

The tape comes in 2” and 4” widths, and I have cut the 2” down to 1” for use on my smaller patients. I have to admit the styling colors and designs are a big hit with my clients.

It is a lot more than just tape on skin. When using kinesiology tape, we aren’t taping for structure but movement. The tape has a lifting effect on the skin and fascia and this is where the real work happens. Improving the space between muscle bellies, between skin and fascia and between fascial planes itself allows the body to have better circulation, improved vasodilation, and improved lymphatic drainage. I have found this effect very helpful for post-surgical patients with edema and swelling. I’ve also used over areas where I anticipate swelling will be and use it pre-emptively.

The tape also has a mechanical effect by lifting on the tissues to allow for better glide. I have found this very helpful on patients with tight muscles from years of postural changes as compensation from osteoarthritis.

Finally, it has a neurological effect. This is two-fold, the first being pain mitigation. We believe this occurs by Gate Theory. Remember from vet school that non-painful stimuli have been theorized to “close the gate” to painful stimuli,

which prevents pain stimulation from reaching the spinal cord.

The other neurological effect is awareness. Small sensory inputs give the body great feedback. In patients with poor posture, the simple application of the tape gives feedback to their nervous system. To me this is like my grandmother always reminding me to “stand up straight.”

For patients with impaired neurological systems (Intervertebral Disc Disease [IVDD], Fibrocartilaginous Emboli [FCE], Degenerative Myelopathy [DM], Lumbosacral Disease [LS]), RockTape provides positive feedback on conscious proprioception.

I had a German Shepherd with degenerative myelopathy that would scuff and drag his hind legs. When I applied the tape to the dorsal aspects of his hind feet, he stopped scuffing. When we took it off, he went right back to scuffing. So we put the tape back on to keep him from scuffing. The principle here is the same as posture. It gave his sensory neurons information telling him where his feet were in space. Without it there just wasn’t enough stimulation of the nervous system to tell him that.

How long does the tape need to be on? This will depend on the condition you’re treating. This could be 12 hours for edema control, 3 - 4 days for pain

My top uses for tape in my practice:1. Cervical pain

2. Trigger points along the vertebrae

3. Stifle support – for luxating patella, cruciate injuries, osteoarthritis

4. Iliopsoas soreness

5. Post-operative soreness/swelling/edema

6. Body awareness – especially for patients recovering from neurological conditions

7. Biceps tendonitis

8. Inflammation/trauma

9. Adhesions/contractions/scar tissue – areas that have caused impairment in limb/body function

10. Part of a multimodal approach to pain management

I also use it on myself. I’m often hunched over patients and I’ve had the tape on myself for all the reasons listed above for my patients. I also use it for postural awareness, to remind me to keep my shoulders back, my head up. By taking care of ourselves, we can take better care of our patients.


mitigation. You may also be applying it every few days to help with sensory perception.

The tape sticks really well to dogs’ coats. I’ve had it on my pit-bull for 3 days straight without a problem and without shaving her. It has stuck on my German Shepherds, Labradors, and Rottweilers. For the longer coated dogs, I do recommend clipping them down. The same rules apply for cats.

Patient selection is very important. While the tape is non-toxic, it has the potential to cause an obstruction if swallowed. Therefore, using it in the hospital, under staff supervision would be a good first step or using an Elizabethan collar with patients so they can’t ingest it.

The vast majority of pets don’t bother the tape, and I’ve had only one report of a very thin skinned Whippet having some skin irritation from the adhesive. If any pet seems

bothered by the tape, it should be removed and the patient evaluated by a veterinarian. Safety first and always.

So while the concept of kinesiology taping has been around for almost 40 years, the technology and science are starting to catch up where we can practically and effectively use it on our dogs and cats. New research will be coming available on applications, but I encourage you to get out there and try it yourselves.

I teach a full day course with a hands-on lab for those of you with further interest in RockTape. Go to www.RockTape.com/Canine for more information on courses. •Matthew Brunke, DVM, CCRP, CVPP, CVA North Country Veterinary Referral Center Queensbury, N.Y.

Photos provided by Matthew Brunke, DVM

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16 March-April 201716

INDUSTRYCornell Hosts Animal Health Hackathon

P eople often begin thinking about becoming veterinarians before they are ten years

old, and they work hard to gain acceptance to veterinary school. As they work even harder for their DVM, however, some students may not be aware of the full potential of their education. The College of Veterinary Medicine (CVM) at Cornell University is working to make sure students are aware of a range of possible career paths for DVMs.

“Our strategy is to build new thinking into our curriculum, to provide students with skills in entrepreneurship and innovation, whether students are pursuing traditional career tracks or exploring opportunities for themselves outside the clinical setting,” says CVM Dean Lorin Warnick.

A recent example is the Animal Health Hackathon at Cornell University. A hackathon is a competition in which student teams drawn from a variety of fields develop ideas for marketable products that solve a problem. Teams then pitch their ideas to a panel of judges from relevant industries. Winners receive cash prizes. The Cornell event partnered CVM students with teammates from other colleges across the University, including business, engineering, computer and information science and design programs.

The Hackathon began with presentations by experts representing a range of animal health occupations, including clinics, startups and academia.

Student presenting her team’s entry to the judges.

Team Retriever and Dean Lorin Warnick, DVM, Ph.D.

Then the participants split into 26 teams and started brainstorming.

On the second day, mentors helped each team refine its idea through “PiNG” meetings –Progress, Needs, and Goals. On the final morning, Hackathon judges—Dr. Monica Dias Figueiredo of Merial; Dr. Andrea Landsberg of Abbott Molecular Diagnostics; Dr. Nick Nelson of Pet Partners LLC; and Dr. Mark Olcott of VitusVet—conducted speed-round judging. Twelve teams were selected to give four-minute presentations in front of the entire audience. Their ideas ranged from a specially-designed comb to make it easier for owners to apply topical medication (Team TransFur) to an auditory processing algorithm for early detection of domestic bird illness (Team Chirp Alert).

Judges then named winners in three ‘vertical’ categories:

Service award: It’s not always possible to “read the label” when shopping online—a big concern for people who want to buy cruelty-free goods. Team Animal Friendly’s web extension helps online shoppers identify which products were created humanely.

Software award: Team Hive Mind proposed software that helps beekeepers quantifiably evaluate the health of their hives. The program uses an algorithm that is able to more accurately and quickly assess how many hive cells are alive vs. dead.

Hardware award: Team Retriever proposed a wearable device that harnesses multiple low-power wireless technologies to maximize the chances that a lost pet is returned. A free

companion app enables the community to help search for and connect lost pets with their owners.

Judges also awarded the Grand Prize to Team Retriever, based on the standout innovativeness and development of its idea. The team was comprised of three DVM students (Erica Feldman, Matthew DiFazio, and Talia Coppens), a computer science student (Ezgi Demirayak) and two information science students (Luis Plaz and Saloni Joshi). The group researched existing technologies, identified needs and surveying veterinary students and pet owners to come up with their device. “We weren’t expecting to win,” says Coppens. “We were so into it for those two

days, we didn’t really see how we compared to the competition.”

“I was very impressed with all the work done over the weekend by all the teams that participated,” says Dean Warnick. “The teamwork by students from disciplines across campus and their interactions with speakers and mentors were highlights of the weekend. It’s very inspiring to see such enthusiasm, creativity, and innovative thinking directed towards animal health and veterinary medicine.”

Claudia Wheatley

Claudia is a writer at the Cornell University College of Veterinary Medicine.

Photo credit: Cornell University College of Veterinary Medicine


ASSOCIATIONNYSVMS Agriculture

Awareness Grant Program

Daniel Duberman ’52Daniel Duberman, 90, Southampton, N.Y., died Nov. 14, 2016. He owned a mixed-animal practice in Southampton for more than 50 years. Dr. Duberman simultaneously served on the natural science faculty of the former Southampton College of Long Island University, serving as an adviser to premedical and pre-veterinary students.

His wife, Julia, two sons, and a daughter survive him. Dr. Duberman’s brother, Dr. Stanley Duberman (Cornell ’59), practiced small-animal medicine in New York’s Westchester County prior to retirement. He donated his body to the medical school at Stony Brook University Hospital.

Clarence McNeil “Neil” Burgher ’58Clarence McNeill “Neil” Burgher, 86, Lewisburg, Pa., passed away Jan. 10, 2017 at Geisinger Medical Center, Danville, Pa. Born July 1, 1930 in New York City at the New York Infirmary (Women & Children’s Hospital), he was the son of the late Clarence and Katherine (McNeill) Burgher of Ozone Park, Queens, N.Y.

He graduated from Whitney Point Central High School, Whitney Point, N.Y. in 1948 and enlisted in the US Army where he served in the US Army Medical Corps from 1948 to 1952 caring for wounded from Korea at Fukuoka, Japan (1950-1952). He graduated

IN MEMORIAM

Colleagues Who Will Be Missedfrom Cornell University in 1957 with a Bachelor of Science in Agriculture and received his Doctorate in Veterinary Medicine from Cornell CVM in 1958.

He became a veterinary associate at the Combs Animal Hospital in Shrewsbury, N.J. from 1958 to 1959; then at Raritan Hospital for Animals, Edison, N.J. from 1959 to 1960. In 1960 he established the Flower 202 Animal Hospital in Branchburg, N.J. which he operated until his retirement.

Dr. Burgher served as a research associate in surgery at the College of Physicians & Surgeons at Columbia University, NYC from 1966 to 1969, and was a consultant in

experimental surgery at various pharmaceutical companies in central New Jersey. He was the head of the Department of Laboratory Animal Care for E.R. Squibb Co., New Brunswick, N.J.

He achieved status as a commercial pilot, instrument rated, and owned or shared ownership in five airplanes. He enjoyed walking and hiked in over thirty countries. He had an ongoing interest in farming and kept cattle and draft horses. He was a Rotarian for many years and was on the Board of Directors of the Appalachian Horse Help and Rescue Association, Linden, Pa. •

T he NYSVMS Agriculture Awareness Grant Program provides regionals funding

to assist local programs that promote agricultural awareness and encourage students to choose a career in large animal medicine and public health. Central N.Y. VMA was awarded a grant in 2016 and used the funds to expand their educational programs for the community at Fesko Farms in Skaneateles. • Pictured at the check presentation: Lydia Aris, DVM, Chris Fesko and Gretchen Schlientz, DVM, President, Central NY VMA.

Practices for SaleWhen buying or selling a veterinary practice, rely on the expertise of Total Practice Solutions Group. See our display ad this issue. Contact Dr. Kurt Liljeberg for a free consultation. (800) 380-6872 or [email protected].

V.T.–Windsor County N.H.–Merrimack County N.Y.– Genesee County N.Y.–Westchester County N.Y. – Franklin County N.Y.– Chenango County Maine–York County Maine–York County Pa. – Huntington County. Visit Nate Lynch & Associates at www.natelynch.com for the latest listings. Contact us via email at: [email protected], or give us a call at: (603) 756-9401.

Brooklyn40 year-old small animal practice for sale. Owner is retiring. Leased building, 3300 square feet. All equipment and supplies included. Private sale at very fair and reasonable price. Serious inquiries only. Email serious inquiries to: [email protected].

Catskill MountainSmall animal clinic in the beautiful Catskill Mountains of Delaware County. Established in 1990. Includes spacious apartment, grooming parlor, and new central heat and air. Perfect for getting out of the “rat race.” Photos on website: http://westbrookveterinaryclinic.com/vetclinictour.html. Please email: [email protected] or call (607) 287-1463.

Hudson ValleyNY164. Thriving satellite practice near up and coming city in Ulster County. No competition in town. Little nearby. Great opportunity to jump start a practice in the area. Asking $325,000 for practice and real estate. For more information, contact Joe Stephenson at (800) 474-4775 or [email protected] for the confidentiality agreement.

Well established Orange County small animal practice in a beautiful facility. Grossing about $500,000, the practice asking price is only $260,000. The owner is offering reasonable rent terms. For more information, contact Joe Stephenson at (845) 943-4998, [email protected] or go to our website, simmonsinc.com, to fill out a confidentiality agreement for NY183 and learn more about the practice.

State of the art facility. Rapidly growing part of Sullivan County. One doctor grossing nearly $1,100,000. Practice and real estate, including a well-kept house: 1.3 million. For more information, contact Joe Stephenson at (845) 943-4998, [email protected] or go to our website, simmonsinc.com, to fill out a confidentiality agreement for NY179 and learn more about the practice.

Lake GeorgeGrossing $975k and growing! One doctor. This small animal practice is busting at the seams with growth potential. Lake George region of the Adirondacks. Practice, real estate and attached house: $970k. For more information, contact Joe Stephenson at (845)

943-4998, [email protected] or go to our website, simmonsinc.com, to fill out a confidentiality agreement for NY178 and learn more about the practice.

New York CityGreat growth opportunity in a high demand market! One-doctor cat practice. 30 minutes outside of Manhattan. Grossing $530,000 with reduced owner hours. Asking $379,995. For more information, contact Joe Stephenson at (845) 943-4998, [email protected] or go to our website, simmonsinc.com, to fill out a confidentiality agreement for NY180 and learn more about the practice.

QueensOne-doctor, small-animal practice in Queens. Grossing just under $300,000. At an asking price of $155,000, this is an easy way to get into practice ownership in an area with few practices for sale. For more information, contact Joe Stephenson at (845) 943-4998, [email protected] or go to our website, simmonsinc.com, to fill out a confidentiality agreement for NY182 and learn more about the practice.

Consolidator OfferIf you have less than 20 offers from consolidators, you’re doing something wrong. Have you been getting offers from consolidators to buy your practice? Are you prepared to negotiate against a giant for the best terms? Reach out today to learn how Simmons is helping veterinarians around the country realize outlandish increases in their consolidator purchase offers. Contact Joe Stephenson, Simmons New York at (845) 943-4998, [email protected].

New Facility Available Westchester Prestigious new veterinary building with boarding facilities and good exposure. Reasonably priced in northern Westchester. Available for immediate occupancy. Zoning approved.Contact Frank Bua at (914) 804-6089 or [email protected].

Vet Facility for Lease FloridaFor lease 6400 sq. ft. former veterinary hospital, Tampa, Fla. Located in high growth area next to downtown Tampa. Large operating room, pre-op and post-op rooms, 3 examination rooms, Hospital A/C. Visit www.vetopportunity.com.

Associate Veterinarians Wanted Central New YorkFull time associate veterinarian wanted for a ten doctor mixed animal practice in Pulaski, N.Y. Position is split between large and small animal duties. Bovine, rectal, and surgical proficiency is a plus. Two well-equipped hospitals with a top-notch staff. Competitive salary and benefits package. View our website at www.northcountryvet.com. Contact Nancy at (315) 298-5141 or email: [email protected]. Send resume to North Country Veterinary Service, P.C., PO Box 70, Pulaski, NY 13142 or fax (315) 298-3221.

Paris Hill Animal Hospital located just outside of New Hartford, N.Y. is seeking a full-time or part-time Associate Veterinarian to join our practice! Our hospital is located in a rural section of the Mohawk Valley of Central New

18 March-April 2017

CLASSIFIED ADSPositions, For Sale and More …

York. We are a regional resource for feline health. We offer generous compensation, medical insurance plan, continuing medical education allowance, vacation, and 401K. For more information, visit our website at: www.parishillcathospital.com. To apply, submit your updated resume in Word format to Kelli Dowhaniuk, Veterinary Recruiter at: [email protected].

Waterville Veterinary Clinic located in Waterville, N.Y. is seeking an Associate Veterinarian! We offer primary care, surgery and dental services, 24-hour emergency service and referrals. Amenities include nine exam rooms, ultrasound, digital x-ray, acupuncture and laser therapy. We are looking for flexibility and a team-player. Emergency medicine experience is a plus. Benefits include 401K, CE allowance and paid time off. To apply, please submit your updated resume in Word format to Kelli Dowhaniuk, Veterinary Recruiter, at: [email protected].

Hudson ValleySeeking an experienced associate to join our small animal hospital in the Hudson Valley. Stone Cottage Veterinary Hospital in Newburgh has undergone a refurbishment to modernize the practice. Minimum of 3 years of experience or internship training in small animal medicine, who can work independently with excellent bedside manner and clear communication skills. Weekend hours are a must (half day Saturdays), but no on-call after-hours emergencies. There also would be buy in potential for the right person. Please send your resume and references to: [email protected].

Long IslandWe have an opening for a full time veterinarian beginning May 2017. We are a rapidly growing practice with an

excellent support staff. Our hospital is a new 5,000 sq.f. facility with state-of-the-art equipment. Our environment allows you to practice as you are comfortable, while at the same time we provide support and mentorship as needed. This is a great opportunity for a veterinarian that wants to be part of something for years to come. See our facility at: townelineveterinarygroup.com. Email your resume to: [email protected] or call the office at (631) 617-5595.

New York CityProgressive, well established three doctor small-animal practice located in Manhattan seeking a part-time associate veterinarian. Services we provide are medical management of cases, routine and comprehensive surgery, full in-house lab, digital radiography, dental services including digital dental radiographs and ultrasound services. We offer a competitive compensation package in addition to a great benefits package, including CE, PTO, membership dues and 401k. Email your CV and cover letter to: Alexandra Jaramillo, LVT, CVT at (212) 712-9600 or email: [email protected].

Westchester Full-time Associate needed for well-established small animal practice in Westchester County.We have been in existence for 25+ years and have a loyal client base. Practice is equipped with new, digital whole body and dental radiology, in-house blood chemistry machine and laser therapy. Support staff includes three full-time licensed veterinary technicians, veterinary assistants and a knowledgeable reception team. Send resume to: [email protected].

Western New YorkBrighton-Eggert Animal Clinic in Tonawanda, NY is seeking an associate DVM to join our practice. Brand new facility! 17,000 sf location. Plus up to $50,000 sign on/retention bonus! We’re looking for a veterinarian to join our team to help cover some of our new hours, but we can be flexible in what this means. We offer generous compensation, medical insurance plan, continuing medical education allowance, vacation, 401K, and relocation support. More information at: www.brightoneggert.com. To apply please send your updated resume in Word format to Kelli Dowhaniuk, Veterinary Recruiter at: [email protected].

Buffalo Small Animal Hospital, located centrally in the city of Buffalo is seeking to hire an associate DVM to join our practice up to $50,000 sign on/retention bonus. Buffalo Small Animal Hospital is in a historic building and provides comprehensive veterinary, surgical and dental care, affordable boarding, grooming, and hospitalization for a population of approximately 260,000. We offer generous compensation, medical insurance plan, continuing medical education allowance, vacation and 401K. More information at: www.buffalovet.com. To apply please submit your resume to Kelli Dowhaniuk at: [email protected].

City Creatures Animal Hospital is looking for an Associate DVM to join their team! This is a well established, busy practice that has sustained incredible growth since opening in November 2007 and is currently expanding into the building next door. We provide primary care, orthopedic and soft tissue surgery, limited emergency service, avian and exotic pet care, and zoo animal care. Go to: www.citycreaturesbuffalo.com or Facebook for more information.

If interested, please submit an updated copy of your resume in Word format to Kelli Dowhaniuk, Veterinary Recruiter at: [email protected].

Veterinarians Wanted Genesee ValleyMonroe Veterinary Associates, Rochester, N.Y., has the following opportunities: FT Associate DVMs: Fairview Veterinary Hospital: 3 doctor practice with a large boarding facility, East River Veterinary Hospital: two doctor practice-exotic interests and experience a plus, Animal Hospital of Pittsford: six plus doctor practice with a large boarding facility, Companion Animal Hospital: two doctor practice, Greece Animal Hospital: three doctor practice; Veterinarian in Charge (VIC): looking for a VIC at one of our three doctor practices and one of our two doctor practices; Rotating Veterinarian: FT position available to work in many of our general practices. Interested candidates may contact Amy Laukaitis, COO at (585) 271-2733 ext. 127 or [email protected].

New York CityNew start-up clinic, fully equipped to meet all veterinary needs of pets, looking for a self-starter, highly motivated, confident, and proactive lead veterinarian. Qualifications: DVM (Medical/Dental/Soft Tissue Surgery), 2+ years’ experience (4+ preferred) and proven record as a producer (revenue generation). Compensation & other benefits: base salary + performance linked incentive compensation structure commensurate with experience and completely customizable per candidate, medical + dental insurance, 401K, paid vacation, sick leave, continuing education, paid license, dues. Please contact The VET Recruiter at 918-488-3902 or [email protected].

March-April 2017 19

Veterinarians Wanted cont’dWestern New YorkNow recruiting a high quality, high volume, Spay/Neuter (HQHVS/N) Veterinarian. Some schedule flexibility. Limited client contacts, no after hour emergencies, and excellent support staff. 1-3 years of small animal veterinary experience helpful. Shelter experience or HQHVS/N specific training a plus. Salary negotiable based on experience. Please email [email protected] or send resume to: Operation PETS, 3443 South Park Avenue, Blasdell, NY 14219.

Relief Veterinarian Available NYC/Surrounding AreasPer diem work & steady part-time in NYC and surrounding metro areas. Available most Mondays, Tuesdays, Wednesdays, Thursdays, and Fridays. Excellent people skills. Good practice builder. 35 years of clinical experience. Many references. Contact Dr. Tobias Jungreis at (917) 378-8447.

Licensed Veterinary Technician WantedLong IslandLicensed or license-eligible LVT FT or PT needed for 5 doctor, small animal/exotic hospital in Massapequa. We practice high-quality medicine and refer to all local specialists. Board certified surgeon and internists visit regularly. Technicians apply full capabilities: anesthesia, radiology (including dental), venipuncture, surgical nursing, dental cleanings and client communications. Please send resume to: [email protected]. •

20 March-April 2017

100 Great Oaks Blvd., Suite 127Albany, NY 12203

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