Providing Specialized Veterinary Care to the Greater York Region

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

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

Specialized Care
What is a veterinary specialist?
Like most health care fields, the veterinary profession has grown and become multi-tiered. Veterinary care for your animal starts with your local veterinarian, the general practitioner. Similar to your family doctor, they provide all general health care and are your animals primary care giver when healthy, ill, or injured. Through the course of its life your animal may develop a problem or injury requiring advanced care and procedures at which time your veterinarian may refer you to a specialist. There are several specialty colleges under the umbrella of the AVMA. The goal of specialty colleges is to create individuals with more expertise in defined areas of veterinary medicine. Specialty colleges ensure/verify that all members meet requirements in regards to training, knowledge and skill. Veterinary specialties include the disciplines of internal medicine, ophthalmology, dermatology, cardiology, oncology, and surgery to name a few.

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 or dermatological conditions, to the physical rehabilitation that helps get them back on their feet, the team at the 404 takes an integrated approach to provide a positive outcome for your pet. In this collaborative environment, our commitment is to provide you with information, service and personal attention and your pet with care that rivals 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 at www.404vet.com Find us on facebook!

How do I get a referral?

If you think your pet would benefit from seeing a specialist, please discuss the possibility of a referral with your family veterinarian. We work closely with your pets primary veterinarian as your pets united healthcare team. In the event of a referral request, your family veterinarian will provide us with your pet's medical history and you are free to call us to make an appointment.

Seeking a second opinion?

Feel free to contact us directly to initiate an appointment.*
*Please be advised for the safety and benefit of your pet that your regular veterinarian will be contacted to ensure we have all of your pets medical history and diagnostics to date.

Surgery
Dr. Kevin Isakow
BVSc, MVSc, Dipl ACVS

What is the difference between my veterinarian and a veterinary surgeon?

All licensed veterinarians may perform surgery as part of their veterinary practice. A Diplomate of the American College of Veterinary Surgeons (ACVS) has completed an approved surgical training program (minimum of a 3-year residency), published research in an area of interest, completed credentialing by the ACVS, and passed a rigorous examination. Only after completion of these requirements and certification as a Diplomate of the ACVS can a veterinarian be considered a veterinary surgical specialist. ACVS Diplomates are held to a higher standard and are expected to provide advanced surgical care and expertise to the animals referred to them. The additional credentials,Diplomate of the ACVS, after a veterinarians name designates that individual as a surgical specialist and ensures the public that the person working with their animal has a certain standardized level of skill and expertise in the field of surgery. Look for the ACVS seal and Diplomate status to know your pet's surgeon is a board-certifed small animal surgery specialist.

Dr. Jim Dundas

DVM, MVSc, Dipl ACVS

Orthopaedic, soft tissue and neurosurgery

All of the surgeons at the 404 Veterinary Referral Hospital have completed surgical internships and residencies and are board certified specialists by the American College of Veterinary Surgeons (Diplomates of the ACVS). We have an array of surgical equipment and 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

Internal Medicine
Dr. Bronwyn Rutland
BSc (VB), BVMS (Hons), Dipl ACVIM

Ultrasound, endoscopy, oncology/chemotherapy

The 404 Veterinary Referral Hospital is pleased to offer consultations with Dr. Bronwyn Rutland, board certified specialist in Small Animal Internal Medicine. Dr. Rutland has considerable experience in private referral practice, having spearheaded the internal medicine service in a busy referral clinic in Melbourne, Australia. She worked most recently at the Ontario Veterinary College teaching veterinary students, interns and residents prior to joining the 404. She prefers minimally invasive diagnostics and has significant experience with endoscopy and diagnostic ultrasound. Dr. Rutland has a number of research interests. Recently, she co-authored a paper describing a novel method of chemotherapy administration. She has also investigated the pharmacokinetics of methimazole in hyperthyroid cats, as well as many infectious diseases, including MRSA and Cuterebra species. Dr. Rutland is committed to her patients and their owners, and endeavors to provide the best care possible. She strives to ensure that her pet owners understand and are comfortable with the diagnostic tests and treatments recommended, and she makes every effort to have timely communication with their family veterinarians to ensure continuity of care. Dr. Rutland is happy to provide over the phone advice to referring veterinarians.

The Internal Medicine Department at the 404 Referral Hospital is able to provide a number of diagnostic and therapeutic procedures. These can include (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 unchartered
waters when a beloved pet receives a cancer diagnosis. At the 404, we are here to help guide pet owners and their families in the decision making process, ensuring that they feel that they are making the right choice for their pets individual needs and quality of life. The Oncology Service at the 404 Referral Hospital is part of the Internal Medicine Service, and is headed by Dr. Bronwyn Rutland. We are able to provide advice and treatment for a number of cancers, including but not limited to:

On the forefront of cancer care

Dr. Rutland has recently been involved in a novel technique to deliver chemotherapy, specifically carboplatin. This research was recently published in the Journal of the American Veterinary Medical Association. This technique involves a single subcutaneous infusion of carboplatin over 5 days (versus the traditional alternative of intravenous carboplatin administered via injection every 3 weeks for 4-6 treatments) for the treatment of appendicular osteosarcoma, with similar survival times obtained when compared with the more traditional method of delivery. This new technique has been used with a number of other cancers, and provides pet owners and their beloved companions another option for chemotherapy, with less visits to the hospital - now that is worth a tail wag any day! The 404 Referral Hospital is very excited to offer this new technique, and is the only place in North America with this experience. Please do not hesitate to contact Dr. Rutland if you would like to discuss this treatment option further.

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

During consultations, clients are educated about the specifics of their pets disease and prognosis and are introduced to the chemotherapeutics and their side effects, as well as palliative care options. The treatment plan and schedule are tailored to each individual patient. Clients are encouraged to play an active part in the treatment process and are closely involved in the decision making. Our integrated approach to cancer diagnosis (Internal Medicine Service) and treatment (Oncology Service) allows for effective and targeted treatment for our patients.

Journal of the American Veterinary Medical Association. Sept. 1, 2012, Vol. 241, No. 5, pages 608-615 Evaluation of a single subcutaneous infusion of carboplatin as adjuvant chemotherapy for dogs with osteosarcoma: 17 cases (20062010) James O. Simcock, Sita S. Withers, Cassandra Y. Prpich, Charles A. Kuntz, Bronwyn E. Rutland

Dermatology
Dr. Stephen Waisglass
BSc, DVM, Cert SAD, Dipl ACVD

Dr. Karri Beck

BSc, DVM, Dipl ACVD

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 visit

Due to the chronic nature and often lengthy medical history which accompanies many pets with dermatological issues, you should expect a slightly longer vet visit than you are used to (many first appointments last 1.5-2 hrs). The dermatology team will review your pets medical history prior to your initial appointment as a means to expedite the history taking portion of your first visit (please see www.404vet.com for both referring veterinarian and client questionnaires to be filled out prior to the appointment). Successful management of dermatological conditions takes dedication and good compliance from pet owners and close oversight by the veterinary dermatologist and family veterinarian working together as an integrated team.

Video otoendoscopy allergy testing treatment of chronic skin/ear/paw/nose conditions

As veterinary dermatologists, Dr. Waisglass and Dr. Beck have an understanding of animal skin disorders that goes beyond skin deep! Their breadth of knowledge allows them to identify skin lesions/sores and the various patterns they form on animals, which in turn aids them in selecting appropriate diagnostic procedures. Using diagnostics such as skin scrapings, skin/ear cultures, biopsies, intradermal skin testing, and elimination diets, veterinary dermatologists are able to get to the bottom of chronic and often very frustrating (for owners and their pets) skin and ear disorders. The dermatology service offers examination and diagnostic 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

Cardiology
Dr. Nevena Borozan
DVM, Dipl ACVIM (Cardiology)

Common indications for seeing a veterinary cardiologist include:

Echocardiography, ECG, Heart failure management

Dr. Borozan graduated from the Ontario Veterinary
College in 1999, and completed an internship in small animal medicine and surgery at the University of Illinois in 2000. Prior to her residency she worked as an emergency clinician at the Veterinary Emergency Clinic in Toronto. In 2007, she started a cardiology residency at Angell Animal Medical Center in Boston and obtained diplomate status in 2010. Her areas of special interest include congenital heart disease, management of congestive heart failure as well as cardiovascular emergencies and interventional cardiology. Dr. Borozan offers full diagnostic work-ups including echocardiography, electrocardiography and radiography of suspected cardiac cases at the 404 Veterinary Referral Hospital.

screening for heart disease prior to introducing a 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

Rehabilitation
Dr. Joanne Fagnou
DVM, CCRP

Dr. Michael Rowland

DVM, CCRP

Sports medicine Neurorehabilitation Acupuncture Hydrotherapy

Dr. Fagnou graduated from the Western College of Veterinary Medicine in 2002. After obtaining certification as a Certified Rehabilitation Practitioner (CCRP) from the University of Tennessee, she also sought and completed training and examinations in veterinary acupuncture through the International Veterinary Acupuncture Society (IVAS). Dr. Mike Rowland studied kinesiology prior to obtaining his DVM as a 2008 Ontario Veterinary College graduate. He completed his CCRP certification in Tennessee in 2008.
Rehabilitation provides for optimal patient outcomes following orthopaedic and neurosurgery, and is a key element in a number of non-surgical neurological conditions (for eg. Fibrocartilagenous Emboli (FCEM), Coonhound Paralysis and Degenerative myelopathy). Along with their neurorehabilitation and orthopaedic rehabilitation caseload, Drs. Fagnou and Rowland also diagnose and treat a variety of soft tissue complaints such as iliopsoas and biceps muscle strains as well as medial shoulder instability (rotator cuff strains). Rehabilitation also alleviates pain from chronic conditions such as arthritis, hip and elbow dysplasia and helps to maintain healthy body weight, mobility and muscle mass (especially in senior pets).

The 404's fully equipped rehabilitation department features two Ferno underwater treadmills, and a 16' x 8' pool with resistance jets to swim against. The underwater treadmills add the element of buoyancy, resistance and range of motion enhancement that land based treadmills cannot rival. The facility also features a ceiling lift mounted on an x-y track to support post-operative orthopaedic and neurological patients and facilitate working with challenging large to giant breed dogs with mobility concerns. Our mission is to support and enable healing and strengthening in our patients and empower their owners to become part of that process. Techniques and modalities available in individually tailored 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

On-site MRI
The 404 is pleased to offer the pet owners of York Region and beyond immediate on-site
access to this valuable diagnostic tool. The MRI provides critical information about the brain and spinal cord non-invasively. Cross-sectional imaging of the nasal cavities and bony aspects of the ear are also invaluable for further classifying the extent of nasal and otic disease. MRI imaging in animals requires the use of a general anesthetic as our animal friends cannot understand the need to stay still while the scan is running. When an MRI is performed as a diagnostic tool immediately prior to performing surgery, it is advantageous to have the MRI on-site to prevent unnecessary additional anesthesia which is neither in patients best interests, nor in the interests of time to the surgery table, which is often critical to the patients prognosis.

One Site, One Team

Your Centre for spinal imaging and surgery
One of the only centres in Ontario
to offer on-site imaging via MRI (the imaging technique of choice for spinal cord disorders), supported by immediate interpretation of images by Board-certified radiologists. Our surgeons have the expertise to evaluate spinal emergency cases (intervertebral disc disease in the back or neck resulting in acute paralysis/weakness, fibrocartilagenous emboli <strokes> and spinal fractures) the technology to evaluate and localize the problem site, and the surgical experience and equipment to deal with these cases. Together with the rehabilitation service, the 404 is pleased to offer a "one site, one team" philosophy for spinal imaging and surgery.

Were relocating & expanding our services in July 2013.

New digs. Expanded services. Same great care.

In July 2013, the 404 Veterinary Referral Hospital will be relocating to a new 10,000 sq ft facility, maintaining its existing complement of specialists and specialized equipment.

Our new location:

Northwest corner of Mulock Drive and Harry Walker Parkway South in Newmarket.

to offer seamless care to all of our patients, emergency and referral alike. All after-hours surgeries will be performed by board-certified surgeons - offering specialist surgical expertise to patients who often need it the most. The MRI will be available for emergency spinal diagnostics around the clock. Stay tuned to our website at www.404vet.com and like us on Facebook to stay updated on our progress with our new venture!

New to the hospital will be the 404s own 24/7 Emergency Service, and the ability

NEW LOCATION Opening JULY 2013

Providing Specialized Veterinary Care to the Greater York Region

1210 Journeys End Circle Newmarket, ON L3Y 8Z6 T. 905 953.1933 F. 905 953.8845 www.404vet.com

Copyright 2012 404 Veterinary Referral Hospital. All rights reserved.

Booklet designed by David Schembri Design 1 800 361 2463 www.dsda.ca