Spring is coming up fast and here at VRCC, we are ready for the sunshine and longer days that comes with it! Our 2019 Spring newsletter is full of information about our Surgery, Cardiology and Internal Medicine teams, as well as upcoming events and news.Meet our two newest Internists, Dr. Elizabeth Groth, and Dr. Kellie Barreto, in the Staff Highlight section.Check out our news and events section that includes information about the 8th annual Battle of the Vet Hospitals Stars, the client coordinators for the Neurology team, and the Ophthalmology team’s commitment to service animals.The Surgery team touches on their goals and availability in the Specialty Highlight section.We hope you’ll enjoy this edition’s case study, “Heartworm Disease Becoming More Prevalent in Colorado with Animal Transport,” written by Dr. Derek Hanes with Rocky Mountain Veterinary Cardiology.Cheers and Happy Spring!Your VRCC Team

SPRING IS ALMOST HERE!

SPRING 2019 NEWSLETTER

3550 South Jason StreetEnglewood, CO 80110(303) 874-PETS (7387)www.vrcc.com

SPECIALTY HIGHLIGHT: SURGERY & ORTHOPEDICS

SPRING CE ANNOUNCEMENT!

For the 3rd year in a row, VRCC will be hosting our Spring DVM CE at the Denver Zoo on Wednesday, May 1st! The event will start at 5pm for registration, with dinner and lectures to follow. Lectures in: Dermatology, Surgery, and Anesthesia/Pain Management will be presented. Before registration and lectures, explore the Denver Zoo from 4pm-5pm with complimentary admission for attendees! This event is free to attend; space is reserved for 125 DVMs only, 3.0 CE credit hours offered. Registration opens on Monday, April 1st and is on a first-come first-served basis. To register, send an email to Ruby Post at rpost@vrcc.com, or call 303-874-2053.

The VRCC Surgery & Orthopedics department’s goal is to help referring veterinarians, and their clients & patients receive the best possible care and treatment, as quickly as possible. The surgery team sees scheduled appointments and performs surgery Monday through Friday from 7am to 5pm; and is on call 24/7 for critical cases presented through the VRCC Emergency department. Our surgeons and anesthesiologists are available for phone consultations from all veterinarians, whether they refer to us or not. Our Surgery team strives to help everyone in the veterinary community with surgical, wound management, medical management (non-surgical), and pain management questions.

We can often get clients in for appointments the same day or next day when they call! If clients come prepared with bloodwork and radiographs in hand from their referring vet, we now offer clients the option of a morning appointment with same day surgery. We work closely alongside internal medicine, oncology, cardiology, and emergency departments here at VRCC to perform surgical procedures, and also have anesthesiologists available for all patients. We have more openings and flexibility than ever, due to us having 4 orthopedic and soft tissue surgeons! We recently welcomed Miriam Talaat, DVM, Diplomate ACVS as our 4th surgeon!

The VRCC Surgery & Orthopedics team can be reached directly at 303-874-2073, or surgery@vrcc.com.

Dr. Miriam Talaat, DVM, Diplomate ACVS joined the

VRCC Surgery & Orthopedics team last March

CASE STUDY: CARDIOLOGY

vena cava with signs of congestive heart failure were identified.

Heartworm disease (dirofilaria immitis) is a nematodal infection that has been documented in all contiguous 48 US states, as well as Hawaii and Puerto Rico. The adult worms often occupy the distal and main branch pulmonary arteries in light infections, however in heavy infections may occupy the right ventricle, atrium, and vena cavae. The life-cycle of the worm starts with the release of microfilariae into the blood stream of an infected animal. They are then picked up during a blood meal by mosquitoes (often of the genus Aedes, Ochlerotatus, and Anopheles) and mature into infective stage 3 larva within the body of the mosquito. Following development to the infective stage, the heartworm travel to the mouth parts of the mosquito, where they are present to infect a new dog during their next blood meal. The larva then molts two additional times into L5 young adults over a following 4-7 months while migrating through body tissues before entering systemic circulation and taking up residence in the pulmonary arteries. This patient had been tested multiple times prior to arrival with repeated negative results. Possible reasons for this might have included the possibility of no adult female worms having developed at this time for detection, as most commercial testing kits test for adult female antigens. This may have either been due to a recent infection and testing during the prepatent period of the worm, or less likely due to single sex infection with

“Heartworm Disease Becoming More Prevalent in Colorado with Animal Transport”By: Dr. Derek Hanes, DVM, Diplomate ACVIM (Cardiology) Rocky Mountain Veterinary Cardiology Molly is a 20-month-old terrier mix that was presented to the cardiology service for evaluation of efforted breathing, coughing, and a heart murmur on February 7, 2019. She was previously adopted from a rescue that transports dogs from Texas and had been with her current guardians for the past two months. She had been tested for heartworm both prior to adoption and following adoption and had tested negative for antigen both times. Two months later, Molly was taken for recheck evaluation for faster breathing and coughing with exertion. A new murmur was identified on examination and radiographs were performed, revealing cardiomegaly. Molly was referred for further evaluation.

Molly presented to the cardiology service for evaluation, and was found to be a bright, alert, and active dog. No audible murmur was identified on presentation; however, an audible mid-systolic click was appreciated. Echocardiographic evaluation was performed, which revealed multiple, echogenic, linear structures occupying the right atrium and extending across the tricuspid annulus with trivial valvular insufficiency consistent with heartworm infection. Additional heartworms were identified extending into the right ventricle and in the distal right pulmonary artery as well. No evidence of distention of the caudal

males only. Concurrent administration of macrocyclic lactone preventative has also been shown to delay the development of immature adult worms, which may have delayed the point at which the worms could have been detected. Alternative theories involve the binding of circulating antigen with native antibodies, making them unavailable for detection by commercial testing kits. The presence of worms in the right atrium is concerning for the potential for development of caval syndrome, characterized by hematuria, red cell lysis and signs of right-sided congestive heart failure due to interference with the tricuspid apparatus. The degree of tricuspid regurgitation in this instance was considered minimal with no evidence of congestive heart failure indicating no evidence of caval syndrome at the time of presentation.It was elected to pursue treatment for Molly in a typical manner with continued monitoring for signs of abdominal distention or other signs of right-sided congestion. Current recommendations for treatment of dirofilarial immitis involve a three-injection protocol given as a single injection, followed by two injections 30 days later, 24 hours apart. This treatment protocol has been found to have an approximate 98% worm clearance rate, as opposed to two injection protocols that have been used with a reported 90% clearance rate. Doxycycline was prescribed as well as an adjunct treatment for symbiotic Wolbachia bacteria required for development of female reproductive parts, which has been shown to increase worm sensitivity to adulticide treatment. Treatment is currently pending, and Molly is doing well at this time.

VRCC NEWS & EVENTSThe VRCC Ophthalmology department is proud to once again be participating in free service dog eye exams during the 2019 ACVO National Service Animal Exam event taking place throughout the month of May. Visit ACVO.org for more details or contact VRCC Ophthalmology directly at 303-874-2070, or eyes@vrcc.com.Rocky Mountain Veterinary Neurology’s Front Line of Client Service and Care: Calm, cool and caring…these are the traits of our client service team that greets you when you call, e-mail or fax. Kayleen, our Senior Coordinator has 12 years of dedication under her belt. Our high-spirited Coordinator, Angela, nicknamed Dr. Lane ‘Hurricane Lane” due to his swift and lively presence on weekends. Lastly, Madison, brings a fresh and bubbly personality to our front desk service. These talented gals pave the way for you and your clients during their visit with RMVN. Visit us at www.rockymountainveterinaryneurology.com to view more fun facts about our staff, access our DVM Referral Form, Neurology Information Sheets for clients, etc. Email us at info@rmvneurology.com or give us a shout at 303-874-2081.

Thoracic radiograph revealing cardiomegaly

Echo image revealing heartworms

Battle News: This year, Battle of the Vet Hospital Stars is taking a “7th Inning Stretch.” This means, we will not be holding the 8th annual BOVHS later this year in September. Instead, Battle will be moved to earlier in the year starting in 2020 (late May/early June). We will also be partnering with a new non-profit organization for the event. Watch for more details to come!Have you accessed our online referral management portal yet? Do you have questions about it, or would like training via phone or on-site? Let us know and we’d be more than happy to help! Our front desk team, department client coordinators, and management team are familiar with how the portal works and can help you navigate through to find your patient’s records. Call us at 303-874-7387 to get some guidance with the portal, or visit the portal at https://vrcc.rvetlink.com/login.asp to get started.Are you getting mail for doctors who are not at your hospital? If so, our apologies! Let us know by emailing rpost@vrcc.com, or calling Ruby Post at 303-874-2053 to get your hospital’s info up-to-date.

Dr. Derek Hanes DVM, Diplomate ACVIM (Cardiology) Rocky Mountain Veterinary Cardiology

STAFF HIGHLIGHT: INTERNAL MEDICINE

Dr. Elizabeth Groth, DVM, MS, Diplomate ACVIMDr. Elizabeth Groth is one of our new Internal Medicine doctors at VRCC! She is from Minnesota and graduated in 2013 from the University of Missouri. After graduation, she completed a small animal medicine and surgery rotating internship at Purdue University, followed by an Internal Medicine specialty internship at Affiliated Veterinary Services in Orlando, Florida. She completed her residency and Master’s degree at the University of Minnesota in 2018, and soon after earned her board certification in Internal Medicine.

Dr. Groth recently moved to Denver and joined the VRCC Internal Medicine team in August of 2018. She enjoys all aspects of internal medicine, but special interests include urology, auto-immune disease, and endocrine disease (particularly disorders of calcium metabolism).Outside of work Dr. Groth enjoys spending time with her husband, Greg, and their two cats, Fat Cat and Little Cat (Layla and Skittles). She also enjoys outdoor activities, especially hiking and skiing. When not exploring the great outdoors, she enjoys reading, brewing her own beer, and is an avid hockey fan. Go Wild!!

Dr. Kellie Barreto, BVMS MRCVS, Practice Limited to Internal MedicineDr. Kellie Barreto was born and raised in sunny Miami, Florida. She attended both Florida International University and Florida State University, earning degrees in Health Sciences and Biological Sciences, respectively. After spending some time in France, she was accepted into the University of Glasgow School of Veterinary Medicine in Scotland. Dr. Barreto graduated with her BVMS veterinary degree in 2013. Dr. Barreto is a member of the Royal College of Veterinary Surgeons and is currently licensed to practice in the UK, New York and Colorado.

After graduation, she completed a one year rotating internship in small animal medicine and surgery at the Veterinary Emergency Clinic and Referral Center in Toronto, Ontario, Canada; and a one year specialty internship in small animal internal medicine and critical care at Gulf Coast Veterinary Specialists in Houston, Texas. She then completed a 3-year residency in Internal Medicine beginning at the Animal Specialty Center in Yonkers, NY, and ending at the Animal Medical Center in Manhattan, NY. She joined VRCC’s Internal Medicine Service in October 2018. While she enjoys all aspects of Internal Medicine, she has a particular interest in immune-mediated hematological disorders. In her spare time, Dr. Barreto enjoys hiking, kayaking, traveling, and fishing; and she looks forward to exploring all that Colorado has to offer. She has one cat named Joon, a previous blood donor who has been enjoying the retired life since 2014.Our Internal Medicine team can be reached directly at 303-874-2055, or internalmedicine@vrcc.com.