Providing Specialized VeterinaryCare to the Greater York Region

Relocating to new premises and expanding services to also include 24/7 Emergency Care in July 2013!

What is a veterinary specialist?Like most health care fields, the veterinary professionhas grown and become multi-tiered. Veterinary carefor your animal starts with your local veterinarian, thegeneral practitioner. Similar to your family doctor, theyprovide all general health care and are your animal’sprimary care giver when healthy, ill, or injured.Through the course of its life your animal maydevelop a problem or injury requiring advanced careand procedures at which time your veterinarian mayrefer you to a specialist. There are several specialtycolleges under the umbrella of the AVMA. The goal ofspecialty colleges is to create individuals with moreexpertise in defined areas of veterinary medicine.Specialty colleges ensure/verify that all membersmeet requirements in regards to training, knowledgeand skill. Veterinary specialties include the disciplinesof internal medicine, ophthalmology, dermatology,cardiology, oncology, and surgery to name a few.

How do I get a referral? If you think your pet would benefit from seeing aspecialist, please discuss the possibility of a referralwith your family veterinarian. We work closely withyour pet’s primary veterinarian as your pet’s unitedhealthcare team. In the event of a referral request,your family veterinarian will provide us with yourpet's medical history and you are free to call us tomake an appointment.

Seeking a second opinion?Feel free to contact us directly to initiate anappointment.*

*Please be advised for the safety and benefit of your petthat your regular veterinarian will be contacted to ensurewe have all of your pet’s medical history and diagnosticsto date.

For all they give, your pet depends on youto provide care for a long and happy life.

Why choose the 404?A small referral practice with a big heart...From complex orthopaedic and soft tissue surgery,spinal surgery, intensive management of medical orderm a tological conditions, to the physical rehab -ilitation that helps get them back on their feet, theteam at the 404 takes an integrated approach toprovide a positive outcome for your pet.

In this collaborative environment, our commitmentis to provide you with information, service andpersonal attention and your pet with care thatrivals and surpasses what is available to humans.

404 Veterinary Referral Hospital –compassionate care since 2007.

Want more information? We invite you to learn more about us atwww.404vet.com

Find us on facebook!

Introduction Specialized Care

What is the difference between myveterinarian and a veterinary surgeon?All licensed veterinarians may perform surgery as partof their veterinary practice. A Diplomate of theAmerican College of Veterinary Surgeons (ACVS) hascompleted an approved surgical training program(minimum of a 3-year residency), published researchin an area of interest, completed credentialing by theACVS, and passed a rigorous examination. Only aftercompletion of these requirements and certification asa Diplomate of the ACVS can a veterinarian beconsidered a veterinary surgical specialist. ACVSDiplomates are held to a higher standard and areexpected to provide advanced surgical care andexpertise to the animals referred to them. Theadditional credentials,“Diplomate of the ACVS”, aftera veterinarian’s name designates that individual as asurgical specialist and ensures the public that theperson working with their animal has a certainstandardized level of skill and expertise in the fieldof surgery.

Look for the ACVS seal and Diplomate status to knowyour pet's surgeon is a board-certifed small animalsurgery specialist.

Dr. Kevin IsakowBVSc, MVSc, Dipl ACVS

Dr. Jim DundasDVM, MVSc, Dipl ACVS

Ortho paedic, soft tissue and neuro surgery

All of the surgeons at the 404 Veterinary ReferralHospital have completed surgical internships andresidencies and are board certified specialists by theAmerican College of Veterinary Surgeons (Diplomatesof the ACVS). We have an array of surgical equipmentand the training necessary to perform:• Advanced orthopaedic procedures such as Total

hip replacement, hip joint capsule denervation, cruciate repair techniques (TPLO, TTA, extra capsular techniques), patellar luxation repairs, fracture repairs (internal and external skeletal fixation available), arthroscopy (shoulder, elbow and knee)

• Soft tissue surgeries: liver shunts, liver lobectomies, gallbladder surgery, reconstructive surgery/skin grafts, intestinal resection/ anastomosis, laryngeal tiebacks, hernia repairs

• Cardio-thoracic surgery: PDA, lung lobectomies• Neurosurgery: stabilization of spinal fractures,

spinal decompression following intervertebral disc prolapse, atlanto-axial stabilization, surgical stabilization for patients with "Wobblers" or lumbosacral disease.

• Surgical oncology

Surgery

Dr. Bronwyn RutlandBSc (VB), BVMS (Hons), Dipl ACVIM

Ultrasound, endoscopy, oncology/chemotherapy

The 404 Veterinary Referral Hospital is pleased tooffer consultations with Dr. Bronwyn Rutland, boardcertified specialist in Small Animal Internal Medicine.Dr. Rutland has considerable experience in privatereferral practice, having spearheaded the internalmedicine service in a busy referral clinic inMelbourne, Australia. She worked most recently atthe Ontario Veterinary College teaching veterinarystudents, interns and residents prior to joining the404. She prefers minimally invasive diagnostics andhas significant experience with endoscopy anddiagnostic ultrasound. Dr. Rutland has a number ofresearch interests. Recently, she co-authored apaper describing a novel method of chemotherapyadministration. She has also investigated thepharmacokinetics of methimazole in hyperthyroidcats, as well as many infectious diseases, includingMRSA and Cuterebra species.

Dr. Rutland is committed to her patients and theirowners, and endeavors to provide the best carepossible. She strives to ensure that her pet ownersunderstand and are comfortable with the diagnostictests and treatments recommended, and she makesevery effort to have timely communication with theirfamily veterinarians to ensure continuity of care. Dr.Rutland is happy to provide over the phone adviceto referring veterinarians.

Internal Medicine

The Internal Medicine Department at the 404Referral Hospital is able to provide a number ofdiagnostic and therapeutic procedures. These caninclude (but are not limited to):

Minimally invasive diagnostic tests:• Endoscopy

Cystoscopy (bladder)

Bronchoscopy (airways)

Gastrointestinal endoscopy

Rhinoscopy (nasal passages)• MRI (on site)• Off-clinic access to CT• Bone marrow & tissue biopsy• Blood tests for infectious diseases

Therapeutic procedures:• Blood transfusions• Chemotherapy• Feeding tube placement• Immune suppression for immune-mediated

disease

Oncology

Many owners find themselves in uncharteredwaters when a beloved pet receives a cancerdiagnosis. At the 404, we are here to help guidepet owners and their families in the decisionmaking process, ensuring that they feel that theyare making the right choice for their pet’s individualneeds and quality of life.

The Oncology Service at the 404 Referral Hospitalis part of the Internal Medicine Service, and isheaded by Dr. Bronwyn Rutland. We are able toprovide advice and treatment for a number ofcancers, including but not limited to:

• Lymphoma• Osteosarcoma• Soft tissue sarcoma• Mast cell tumor• Adenocarcinoma• Transitional cell carcinoma • Hemangiosarcoma

During consultations, clients are educated aboutthe specifics of their pet’s disease and prognosisand are introduced to the chemotherapeutics andtheir side effects, as well as palliative care options.The treatment plan and schedule are tailored toeach individual patient. Clients are encouraged toplay an active part in the treatment process andare closely involved in the decision making.

Our integrated approach to cancer diagnosis(Internal Medicine Service) and treatment(Oncology Service) allows for effective and targetedtreatment for our patients.

On the forefront of cancer care

Dr. Rutland has recently been involved in a noveltechnique to deliver chemotherapy, specificallycarboplatin. This research was recently publishedin the Journal of the American Veterinary MedicalAssociation. This technique involves a singlesubcutaneous infusion of carboplatin over 5 days(versus the traditional alternative of intravenouscarboplatin administered via injection every 3weeks for 4-6 treatments) for the treatment ofappendicular osteosarcoma, with similar survivaltimes obtained when compared with the moretraditional method of delivery. This new techniquehas been used with a number of other cancers,and provides pet owners and their belovedcompanions another option for chemotherapy,with less visits to the hospital - now that is wortha tail wag any day!

The 404 Referral Hospital is very excited to offerthis new technique, and is the only place in NorthAmerica with this experience. Please do nothesitate to contact Dr. Rutland if you would liketo discuss this treatment option further.

Journal of the American Veterinary Medical Association.Sept. 1, 2012, Vol. 241, No. 5, pages 608-615Evaluation of a single subcutaneous infusion of carboplatin asadjuvant chemotherapy for dogs with osteosarcoma: 17 cases(2006–2010)James O. Simcock, Sita S. Withers, Cassandra Y. Prpich, Charles A. Kuntz, Bronwyn E. Rutland

Dermatology

Dr. Stephen WaisglassBSc, DVM, Cert SAD, Dipl ACVD

Dr. Karri BeckBSc, DVM, Dipl ACVD

Video otoendoscopyallergy testingtreatment of chronicskin/ear/paw/nose conditions

As veterinary dermatologists, Dr. Waisglass and Dr.Beck have an understanding of animal skindisorders that goes beyond “skin deep”! Theirbreadth of knowledge allows them to identify skinlesions/sores and the various patterns they form onanimals, which in turn aids them in selectingappropriate diagnostic procedures. Using diag -nostics such as skin scrapings, skin/ear cultures,biopsies, intradermal skin testing, and eliminationdiets, veterinary dermatologists are able to get tothe bottom of chronic and often very frustrating (forowners and their pets) skin and ear disorders.

The dermatology service offers examination anddiagnostic testing for:• Allergic skin disease• Infectious skin disease (i.e. bacterial, fungal, viral)• Parasitic skin disorders• Dander related conditions• Alopecia (hair loss)• Congenital skin disorders• Auto-immune disease

• Benign and malignant skin cancers• Chronic ear infections• Skin disorders relating to hormonal imbalances

and other internal (systemic) causes

What to expect on your first visitDue to the chronic nature and often lengthy medicalhistory which accompanies many pets withdermatological issues, you should expect a slightlylonger vet visit than you are used to (many firstappointments last 1.5-2 hrs). The dermatology teamwill review your pet’s medical history prior to yourinitial appointment as a means to expedite thehistory taking portion of your first visit (please seewww.404vet.com for both referring veterinarian andclient questionnaires to be filled out prior to theappointment). Successful management of derm -atological conditions takes dedication and goodcompliance from pet owners and close oversight bythe veterinary dermatologist and family veterinarianworking together as an integrated team.

Cardiology

Dr. Nevena BorozanDVM, Dipl ACVIM (Cardiology)

Echocardiography, ECG, Heart failure management

Dr. Borozangraduated from the Ontario VeterinaryCollege in 1999, and completed an internship insmall animal medicine and surgery at the Universityof Illinois in 2000. Prior to her residency she workedas an emergency clinician at the VeterinaryEmergency Clinic in Toronto. In 2007, she started acardiology residency at Angell Animal Medical Centerin Boston and obtained diplomate status in 2010.

Her areas of special interest include congenital heartdisease, management of congestive heart failure aswell as cardiovascular emergencies andinterventional cardiology. Dr. Borozan offers fulldiagnostic work-ups including echocardiography,electrocardiography and radiography of suspectedcardiac cases at the 404 Veterinary Referral Hospital.

Common indications for seeing a veterinarycardiologist include:

• screening for heart disease prior to introducinga pet into a breeding program

• pre-purchase screening• evaluation prior to anesthesia• evaluation of newly acquired heart murmur• detection of arrhythmia at routine health exam• cough• exercise intolerance/weakness• fainting episodes• abdominal swelling

Dr. Joanne FagnouDVM, CCRP

Dr. Michael RowlandDVM, CCRP

Sports medicineNeurorehabilitationAcupunctureHydrotherapy

Dr. Fagnou graduated from the Western Collegeof Veterinary Medicine in 2002. After obtainingcertifi cation as a Certified Rehabilitation Practitioner(CCRP) from the University of Tennessee, she alsosought and completed training and examinations inveterinary acupuncture through the InternationalVeterinary Acupuncture Society (IVAS). Dr. MikeRowland studied kinesiology prior to obtaining hisDVM as a 2008 Ontario Veterinary Collegegraduate. He completed his CCRP certification inTennessee in 2008.

Rehabilitation provides for optimal patientoutcomes following orthopaedic and neurosurgery,and is a key element in a number of non-surgicalneurological conditions (for eg. FibrocartilagenousEmboli (FCEM), Coonhound Paralysis andDegenerative myelopathy). Along with their neuro -rehabilitation and orthopaedic rehabilitationcaseload, Drs. Fagnou and Rowland also diagnoseand treat a variety of soft tissue complaints such asiliopsoas and biceps muscle strains as well asmedial shoulder instability (rotator cuff strains).Rehabilitation also alleviates pain from chronicconditions such as arthritis, hip and elbow dysplasiaand helps to maintain healthy body weight, mobilityand muscle mass (especially in senior pets).

The 404's fully equipped rehabilitation departmentfeatures two Ferno underwater treadmills, and a 16'x 8' pool with resistance jets to swim against. Theunderwater treadmills add the element of buoyancy,resistance and range of motion enhancement thatland based treadmills cannot rival. The facility alsofeatures a ceiling lift mounted on an x-y track tosupport post-operative orthopaedic and neurologicalpatients and facilitate working with challenginglarge to giant breed dogs with mobility concerns. Ourmission is to support and enable healing andstrengthening in our patients and empower theirowners to become part of that process.

Techniques and modalities available in individuallytailored programs include:

• Therapeutic Ultrasound• Phonophoresis• Low Level Laser Therapy• Acupuncture • Neuromuscular Electrical Stimulation (NMES)• Transcutaneous Electrical Neuromuscular

Stimulation (TENS)• Myofascial Release and Trigger Point Therapy• Targeted home exercise prescription• Hydrotherapy

Additional services include:• Fitness and wellness programs to boost the

performance of elite sporting dogs (and backyard athletes!) as well as to support senior pets who just need a little help keeping mobile

• Day and overnight boarding: A great place to stay for patients who would also benefit from daily rehab sessions

Rehabilitation

On-site MRI One Site, One Team

Your Centre for spinalimaging and surgery

One of the only centres in Ontarioto offer on-site imaging via MRI (the imagingtechnique of choice for spinal cord disorders),supported by immediate interpretation of imagesby Board-certified radiol ogists. Our surgeons havethe expertise to evaluate spinal emergency cases(intervertebral disc disease in the back or neckresulting in acute paralysis/weakness, fibro cartil -agenous emboli <strokes> and spinal fractures)the technology to evaluate and localize theproblem site, and the surgical experience andequipment to deal with these cases. Together withthe rehabilitation service, the 404 is pleased tooffer a "one site, one team" philosophy for spinalimaging and surgery.

The 404 is pleased to offer the pet ownersof York Region and beyond immediate on-siteaccess to this valuable diagnostic tool. The MRIprovides critical information about the brain andspinal cord non-invasively. Cross-sectional imagingof the nasal cavities and bony aspects of the earare also invaluable for further classifying the extentof nasal and otic disease. MRI imaging in animalsrequires the use of a general anesthetic as ouranimal friends cannot understand the need to staystill while the scan is running. When an MRI isperformed as a diagnostic tool immediately priorto performing surgery, it is advantageous to havethe MRI on-site to prevent unnecessary additionalanesthesia which is neither in patient’s bestinterests, nor in the interests of time to the surgerytable, which is often critical to the patient’sprognosis.

We’re relocating & expanding our services in July 2013.

New digs.Expanded services.Same great care. In July 2013, the 404 Veterinary Referral Hospitalwill be relocating to a new 10,000 sq ft facility,maintaining it’s existing complement of specialistsand specialized equipment.

New to the hospital will be the 404’s own24/7 Emergency Service, and the abilityto offer seamless care to all of our patients,emergency and referral alike. All after-hourssurgeries will be performed by board-certifiedsurgeons - offering specialist surgical expertise topatients who often need it the most. The MRI willbe available for emergency spinal diagnosticsaround the clock.

Stay tuned to our website at www.404vet.com and“like” us on Facebook to stay updated on ourprogress with our new venture!

Our new location: Northwest corner of Mulock Drive and Harry Walker Parkway South in Newmarket.

NEW LOCATIONOpening

JULY 2013

Providing Specialized VeterinaryCare to the Greater York Region

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1210 Journey’s End CircleNewmarket, ON L3Y 8Z6

T. 905 953.1933F. 905 953.8845www.404vet.com

Copyright © 2012 404 Veterinary Referral Hospital. All rights reserved.