Referral Pearl

Volume 5. Issue 2                                                    

New Patient Service Representatives and Phone Process

To better serve our referring community and our Clients, we have recently expanded and reorganized our Client Service Department to include Patient Service Representatives (PSRs).  Each specialty department has been assigned a designated PSR or two who will be responsible for answering their departmental calls from 8am - 5pm, Monday through Friday. The PSRs have received specific training for their assigned department.  Our goal is to provide consistent, knowledgeable and responsive communication that will assist in the referral process and the Client relationship.

Client Service Representatives will answer phones from 5pm - midnight, Monday through Friday and 7am - midnight Saturday and Sunday.  Technicians will be responsible for phone calls from midnight to 7am every day of the week.

Call Flow: (No general options):
  • Prompt 2 = ER and In-Hospital Patient Updates (one PSR)
  • Prompt 3 = Neuro (two PSRs)
  • Prompt 4 = IM (one PSR)
  • Prompt 5 = Address and Directions (CSRs)
We would like to say a special "Thank You" to our Top 25 Referring Facilities!  We are grateful for your partnership in Patient Care!

Hillside Veterinary Clinic
DVSC - Dallas
Vetsavers Pet Hospital
Animal Clinic of Farmer's Branch

MedVet Dallas
VCA ADC - Dallas

Banfield - Lewisville
Frisco Emergency Pet Care
Legacy Veterinary Hospital
All Care Veterinary Hospital
VCA Angel Flower Mound
VCA Metroplex
All Creatures Veterinary Center
Family Pet Center (Frisco)
Timber Valley Pet Hospital
Community Pet Outreach
AEAH of Mansfield
Vitality Pet Care
Banfield - Josey Oaks
City Vet (Oaklawn)
Lazy Paw Animal Hospital
Valley Ranch Pet Clinic
Veterinary Eye Institute
Main Street Veterinary Hospital
McKinney Animal Hospital

Referring Reminders
  • Complete Patient Referral Form on-line via our website, email or fax.
  • Forward records, Doctor's notes, lab data, radiographs, ultrasound/echo, etc.
  • Complete Patient Referral Form in full including the requested "appointment type":
    • Regular (7-10 days)
    • Urgent (3-5 days)
    • Immediate (Today) - Call the office
  • Emergency ER referrals require a "Doctor to Doctor" phone call prior to sending the Client.   This will allow you the opportunity to prepare your Client for their visit to CVSEC (expectations, description of referral and general pricing estimates/ranges).
  • Typically, Specialty ER's can be seen on the same day IF the Client arrives before 4:00pm and there has been a "Doctor to Doctor" consultation.
  • Specialty ER referrals after 4:00pm will be seen by our E/CC Department and depending on the treatment plan may transfer to a Specialist the next business day.  We do have designated Doctors on-call for Specialty emergencies that can't wait.
  • Patient Registration and ER Pre-registration can be completed on our website.
  • Marketing materials can be ordered through our website CVSEC Marketing Materials
We would like to thank all of our Referring Partners who attended Dr. Mahon's presentation, When You Can't Catch a Break or Your Breath (Management of Acute Respiratory Crisis), at the Collin County Veterinary Medicine Association meeting last week.  We had a fabulous turnout and appreciate everyone's support! 

Dr. Mahon is available to speak at your location during a scheduled "Lunch and Learn".  If interested, please contact Shelley Martin at 972.820.7099 or
Copyright © 2020 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:
Center for Veterinary Specialty + Emergency Care
2700 Lake Vista Drive
LewisvilleTX 75067

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Referral Pearl
Volume 5. Issue 3
May 2019


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I’m sure most of you will agree…our job as Veterinarians is MUCH more difficult than that of a “real doctor” of human medicine.  Case in point:  my brother accidently cut his finger once and went to hand specialist – I cynically asked if he was a right hand or left hand only Specialist.  My bother replied “Neither, he works on both…but only the index fingers.”
But as general practitioners, you DO have a tough job.  In the course of a day, and on multiple species, you practice dentistry, dermatology, general surgery, nutrition, ophthalmology, and radiology…along with infectious disease control and a little psychologist (behaviorist) mixed in.
Considering this, it’s important to remember one thing – while trying to be a “jack of all trades” you risk being a “master of none.”  Despite the perfectionism streak in many of us, we can’t know everything (believe me, as a perfectionist in recovery, I’ve tried).  Hence, the rise of us Specialists.  Some of us like to repair crunchy bones or take out the bad tissue.  Others (like me) enjoy the puzzle solving aspect of internal medicine.  Still others just like to focus on one area…like the wiggly thing in the thorax or the “windows to the soul.”  But no matter our Specialty, we all worked hard to gain additional skills and experience that allow us to better serve Patients when called upon.
So, what’s keeping you from calling on us?  How can we work together for the benefit of the Patient(s) and their chauffeurs?  Here’s a few reasons to refer:

Enhanced Care AND Saving Money
Even in an area as large as the DFW Metroplex, one specialty hospital cannot do it all.  If you assemble a strong referral team, you can provide a higher standard of care, irrespective of a Patients’ unique needs. 
And, who doesn’t like to save money?  The Specialist care may cost more initially but getting an answer faster and the proper therapy initiated saves time, money and most importantly, heartache.
Finally, your operating hours or lack of expensive equipment can limit the services you provide and introducing new services may not be economical for your practice.  Working closely with Specialists (esp. those with an integrated ER like our Hospital) gives your Clients the services and after hours support they need while not adding strain to your budget.  Referring to Specialists allows you to focus on other areas of your practice…and life (remember work/life balance!).

Patient (and their Chauffers’) Retention

Who likes to return to a business for multiple visits because of the same issue?  OK, maybe my grandmother…it gives her something to do besides watch The Price is Right.  But often our Clients become upset when they return for the same problem because it wasn’t “fixed” (believe me, as an Internist I know this isn’t a realistic goal in many cases).  And, a Client may not even give you multiple chances, instead acting on the advice of a neighbor, breeder, co-worker, pet store employee, groomer, or (shudder) Dr. Google.  You likely won’t see this Client again, and you certainly won’t get additional chances if the Patient succumbs to their disease process (morbid but true).  Discussing referral sends the message that you have a Patient’s best interests at heart and not your ego or balance sheet, which will keep them coming back because they trust you.

Free Advice
None of us got into Veterinary Medicine to get rich.  My Mom still laments I didn’t become a plastic surgeon and help her get rid of her “turkey wattle.”  We Specialists are happy to help you, whether it means discussing a Patient’s situation or recommending a medication.  But don’t exploit it.  Calling me weekly to discuss several cases or sending me 145 pages of medical records to “chat” about – when the last referral you sent me was in 2009 – is disrespectful.
Speaking of learning – we Specialists can help you grow in knowledge from every referral.  Our communications keep you up to date with diagnostics, treatments and outcomes, which in turn allows you to learn and be able to diagnose issues that you would not have recognized previously.  Many Specialists provide local CE (like the excellent ones you get monthly at your CCVMA Meetings), and we also provide free continuing education in the form of “lunch and learns” for you and your Team; just contact our Referral Relations Coordinator Shelley Martin ( to schedule!

Knock knock.
Who’s there?
A wise person once told me that if you practice veterinary medicine, no matter how careful you are, you will eventually find yourself getting sued and/or reported to the state board.  I didn’t expect it to happen 6 months into my internship, but at least I got it out of the way early in my career!  If you find yourself in a legal tussle, having offered a referral may be a deciding factor.  In fact, Texas Administrative Code (Rule §573.24 – Responsibility of Veterinarian to Refer a Case) explicitly states “a veterinarian shall have a duty to a client to suggest a referral to a specialist…in any case where the care and treatment of the animal is beyond the veterinarian's capabilities.” 

Avoid “preconceived notions”
How many times have you seen a case and the diagnosis was obvious…but you or your colleague missed it previously?  We all make mistakes, and most of us learn from them.  Think of these scenarios and you’ll likely have a Patient come to mind:  lameness diagnosed as hip dysplasia but due to a torn CCL…pancreatitis vs. IBD…endocrine issues vs. atopy…IVDD vs. polyarthropathy, paraneoplastic vs. autoimmune disease…and the list goes on.
We all learn the material in vet school, but the advanced training Specialists receive give us a focused experience that comes into play with so many cases.  As Specialists, we know the advanced testing that is needed to get an answer quickly and which procedures would better serve a Patient.  Therefore, please don’t just send the case over with your requested diagnostic or procedure…send them over for a consultation and discussion. 
For example, unless you hate me, please don’t send the 200 lb aggressive Rottweiler for an abdominal ultrasound to find adrenal glands and the Clients are against sedation for religious reasons – that dog needs an abdominal CT scan.  Do your best to avoid preconceived notions and steer the Client in our direction before the wrong procedure is recommended or performed.

Patient and Client Advocacy / Support
We all know that for some Patients, treatment is not possible, or ethically even recommended.  Along with euthanasia, hospice care should be discussed.  This may only be for a short period, but it may be the time that is needed to allow the Client to process their emotions while supporting their loved one and ensuring they are pain free with an acceptable Quality of Life.  At our Hospital, we have a dedicated team of Veterinary Social Workers (VSWs) who help Clients with these complex issues, and this lessens the emotional burden on you and your team as well.  There is no charge for this service, and our VSWs also have monthly support groups that are open to your Clients, too (more information can be found at

Final thoughts…
I hope this article made you laugh and re-examine your referral (or non-referral) policies.  I also hope we can we work together for the benefit of many Patients (including the 200 lb aggressive Rottweiler), and here are a few final pointers on how to “refer better”:

  • DO fill out the referral form and PLEASE include a summary of what you have done or administered.  You like our summaries, right?  I know you’re busy, but it will only take you 5 minutes.  Just do it.
  • DO specify any questions you may have.  Remember, we want to help you grow in your knowledge.  This will only add 1 minute to your writing of the summary.
  • DO send the medical record – all copies of bloodwork, imaging and other tests.  It makes us both look silly if we don’t have the information we need. 
  • Do NOT refer Clients who have exhausted their financial resources.  This is not a win-win situation.  It makes me sad when someone says, “they never told me it would cost me money.”  Huh?
  • Do NOT give medications that may interfere with further treatment unless critical.  That includes prednisone.
  • Do NOT send this (or at least call and warn us first so we can grab the fire extinguisher and hip waders):

Keven Gulikers, DVM, MS, DACVIM (SAIM)

Dr. Gulikers received his Doctorate in Veterinary Medicine from Oklahoma State University College of Veterinary Medicine in 1998 (Go Pokes!) and completed a private practice internship in 1999 in south Florida.  In 2002 he completed a residency in Small Animal Internal Medicine and earned a Master of Science degree in Veterinary Medical Sciences at Virginia-Maryland Regional College of Veterinary Medicine.

After his residency, he worked in specialty private practice in Phoenix for several years before moving to Dallas.  Dr. Gulikers has instructed and published on various subjects in his field.  He is Board-Certified by the American College of Veterinary Internal Medicine, and his interests include gastroenteritis, liver disease, endocrinology (especially thyroid-related diseases) and diagnostic procedures such as abdominal ultrasonography, endoscopy and laparoscopy.

When not practicing, Dr. Gulikers enjoys playing soccer, traveling, SCUBA diving, and spending time with his wife and daughter.  If you have a grumpy 200 lb Rottweiler that needs a consult, he can be reached at




Copyright © 2019 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067

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Referral Pearl
Volume 5. Issue 4


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Introducing Dr. Marguerite Mezzles...

Dr. Mezzles grew up in Texas and is a proud Aggie (WHOOP!)  She graduated from Ross University in 2011 and subsequently completed a rotating internship at Oklahoma State University, two surgical internships (ASEC Los Angeles and LVVSC Las Vegas), and a research fellowship at Texas Biomedical Research Institute in San Antonio.  Her surgery residency was completed at Summit Veterinary Referral Center in Tacoma, and she is excited to be back home! 

Her specific areas of interests include soft tissue cases, especially wound management and surgical oncology, as well as the growing use of minimally invasive procedures.

Outside of work, Dr. Mezzles enjoys music and theater, watching and playing sports, quilting, traveling, and doing anything that involves being in the water.  She is eager to return to Texas with her husband and two Scottish Folds.

Marguerite Mezzles, DVM
(Limited to the Practice of Surgery)

Dr. Mezzles will be joining our Team on August 1, 2019.  She will be visiting several of our referring hospitals shortly thereafter.  Please contact Shelley Martin if you would like to schedule a visit for a specific day and/or time @ 972.820.7099 or




Copyright © 2019 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067

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Referral Pearl
Volume 5. Issue 1

February 2019

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The Center for Veterinary Specialty + Emergency Care is now offering an Animal Caregiver Support Group and your Clients are invited to participate. 

Do you have Clients that are caring for their beloved Pet who is chronically ill, elderly, has special needs, or who has been diagnosed with a terminal illness?  Are they concerned with decision making or quality of life questions?  Is their around the clock need for care wearing them down?

Caregiving can be stressful, emotional, and lonely.  We at CVSEC invite any of your Clients to meet others in similar situations to share compassion, support, and solutions.  Educational topics and materials will be provided.

The group is held at CVSEC on the last Sunday of each month (beginning February 24, 2019) from 2-3:30 pm.  The group is facilitated by our Veterinary Social Worker, Sandra Brackenridge, LCSW, BCD and social work interns under her supervision.  Please call 972.820.7099 for additional information.

We continue to host our Pet Loss & Grief Support Group for those that have had a Pet die or anticipating death.  These meetings are also held at CVSEC and are twice a month on the 2nd and last Saturdays from 1-2:30 pm.  All group meetings are free of charge.

Amanda Brenna, DVM, MS
Practice Limited to Neurology/Neurosurgery

Dr. Brenna graduated from the Washington State University College of Veterinary Medicine in 2013.  She completed a small animal medicine and surgery internship in Seattle, and a Neurology/Neurosurgery specialty internship here at CVSEC.  She went on to complete a three-year residency program at Auburn University, before returning to Dallas in August of 2018.  She is very excited to be back with her CVSEC family!

Dr. Brenna's specific areas of interest are neuro-oncology and inflammatory diseases of the central nervous system.

When not at work, Dr. Brenna enjoys playing the piano, painting, cooking, exploring the city, and traveling to visit friends and family.  She shares her home with a very handsome tail-less cat named Toulouse, and a very tiny dog named Lady Marseille Chickenbones.

We are thrilled to have Dr. Brenna back at CVSEC!!  She is a wonderful addition to our Neuro specialty department!
Sonya Hansen, DVM, MS
Diplomate ACVECC
Emergency & Critical Care

Please meet the newest member of our E/CC Team, Dr. Sonya Hansen!

Dr. Hansen completed veterinary school at the University of Minnesota in 2013.  After that she did a one-year rotating internship at Michigan State University, followed by a one-year internship in Emergency & Critical Care at Auburn University.  She stayed at Auburn University for a three-year residency in Emergency & Critical Care.  She began working at CVSEC in October of 2018.

She has held many jobs in the veterinary field, starting as a kennel assistant prior to veterinary school.  She worked throughout veterinary school as a veterinary assistant at a local general practice in Minnesota. 

Dr. Hansen's professional interests include trauma, toxicities, shock, and continuous renal replacement therapy.

In her spare time, Dr. Hansen enjoys spending time with her fiancé and her many Pets (3 dogs and 2 cats!).  She also enjoys being outdoors, working out, traveling, and exploring new breweries and restaurants.

We are honored to have Dr. Hansen as a member of our E/CC Team!!

Copyright © 2019 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:
Center for Veterinary Specialty + Emergency Care
2700 Lake Vista Drive
Lewisville, TX 75067

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Referral Pearl
Volume 4. Issue 5

November 2018

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Neurosurgery and Critical Care

Patient:  Seven

Seven presented to our Neuro Emergency service on a Friday for a sudden onset inability to use her pelvic limbs.  Her initial neurologic exam localized her spinal cord injury to her thoracolumbar spine (the middle of her back).  At that time she was paralyzed and did not have any feeling or pain sensation in the toes of her back legs or her tail.  This is the most severe grade of spinal cord injury and her prognosis for recovery of neurologic function was considered guarded to poor.  Dogs with this severity of spinal cord injury only have a 50% chance of regaining normal function, and only if there is an injury that we can perform surgery on.  Seven had an MRI performed that same day and was diagnosed with a compressive spinal cord injury between the first and second lumbar vertebrae (L1-L2).  The lesion was consistent with a high velocity/low volume disc herniation (what is now referred to as Acute Non-compressive Nucleus Pulposus Extrusion) and a secondary hematoma (blood clot) formation.

Acute non-compressive nucleus pulpous extrusions do not typically require surgery, but in Seven's case there was a large hematoma formation that was causing enough compression of the spinal cord that surgery was warranted to decompress the spinal cord.  A hemilaminectomy was performed that night and during surgery a large blood clot was removed from around the spinal cord to decompress it.  Seven recovered uneventfully from surgery and the following morning was neurologically stable, but remained paralyzed with absent pain sensation to her pelvic limbs and tail.

Seven remained in the Hospital for the next five days to manager her post operative pain and monitor her for signs of neurologic improvement.  At discharge she appeared to be regaining some very subtle signs of returning feeling to her toes and we were very hopeful with her long term prognosis.  Since she was still paralyzed in her back end, she needed to have her bladder manually expressed several times per day to empty it and the owners were instructed in how to manually express it.

Two days later Seven re-presented to our emergency service for abdominal pain, loss of appetite and vomiting.  She was diagnosed with uroabdomen (urine within the abdominal cavity) and a ruptured bladder.  Seven transferred to the care of Dr. Mahon and our Critical Care team.

Uroabdomen is a life threatening condition in dogs and cats and occurs when some portion of the urinary tract is ruptured. The most common cause of uroabdomen in cats are due to obstruction of the urethra, and in dogs, trauma is the leading cause.  In rare circumstances, bladder expression can cause uroabdomen.  This was the case with Seven. The family was performing bladder expressions dutifully as they had been shown.  Seven then became restless and started to vomit.  By the time she presented to CVSEC, she was in shock, an AFAST scan showed free fluid in her abdomen, and she was azotemic and hyperkalemic.  A sample of the abdominal fluid was run through the chemistry analyzer and the creatine and potassium differentials compared to her blood levels supported a uroabdomen.  Uroabdomen can give rise to life threatening hyperkalemia.  For Seven's emergent treatment, she received IV fluids, calcium to protect her heart, and dextrose and insulin to help sequester potassium.  A urinary catheter was placed, and we inserted a fenestrated MILA chest tube into the abdominal cavity to act as a peritoneal drain.  A positive contrast cystourethrogram study was done to confirm and localize the bladder tear at the apex of the bladder.

Seven responded well to the therapies and came out of shock fairly quickly.  The next conundrum was what to do about her bladder?  Clearly, repairing it was necessary, but her spinal injury left her no control of bladder function, so bladder expressions would still be necessary.  But pressing on a compromised, recently repaired bladder was far too risky.  We contacted Dr. Patti Sura at DVSC, and she agreed to repair the bladder, but also place a cystostomy tube, so that Seven's bladder could be drained without having to compress it.  Seven had the surgery, and 7 weeks later, the bladder tube is out, she is able to urinate on her own perfectly normally, and she can get around very well!  She still demonstrates ataxia (a drunken-sailor type walk) in her hind legs which may continue to improve with time.  She wags her tail, eats her treats and is a wonderful Pet and Patient!

Throughout her hospitalization for her uroabdomen, we became more convinced that she regained her feeling in her toes of her pelvic limbs.  Fourteen days after her hemilaminectomy (while hospitalized for her uroabdomen) she regained voluntary movement of both her pelvic limbs and her prognosis for neurologic recovery was considered good to excellent!  One month later at her neurologic recheck exam she was ambulatory without any assistance and was urinating normally.  She was also back to acting like a happy, healthy, energetic four year old boxer!  She will likely continue to neurologically improve over the next 2-3 months and is considered to have an excellent prognosis for eventually returning to a normal gait and normal activity levels.


Dr. Mahon, Seven and Dr. Williams at check-up
Update 11.7.18:
"Seven is back to being herself after several surgeries, and physically she is probably 75% recovered.  She walks without much issue - We took her on a four mile walk this weekend so her stamina is back.  Her lateral stability is reduced, but she still runs, using a combination of hopping and skipping that is really something to watch, but it works for her!.  We are all (including her brother, Jeter) thankful to have her home and living a normal life."

Don and Deneen Barnwell

Here is Seven showing off for her doctors at her 30 day re-check appointment!
Copyright © 2019 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:
Center for Veterinary Specialty + Emergency Care
2700 Lake Vista Drive
Lewisville, TX 75067

Add us to your address book

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.


Referral Pearl
Volume 4. Issue 4

September 2018                                                                     View this email in your browser


Domestic violence, also called intimate partner violence, can occur in any relationship between two individuals, and does not always involve physical violence, as previously thought.    In fact, domestic violence can be any combination of emotional, financial, sexual, or physical abuse.  In general, domestic violence occurs when one partner within a relationship communicates in a way that is hurtful, threatening, insulting, or demeaning with the intention of manipulating and controlling the other partner.  There are many indicators or "red flags" a person displays that may be indicative of a person's abusive nature.  These "red flags" include, but are not limited to, a person wanting to move too quickly in a relationship, does not honor another person's boundaries, someone who seems "too good to be true" and flatters constantly early in the relationship, is excessively jealous, attempts to monopolize all of another person's time and insists that time spent with others is unnecessary, as well as insistence on less time spent on activities such as hobbies and work.

On the average , 20 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States - equaling more than 10 million men and women annually.  In other words, 1 in 3 women and 1 in 4 men will experience some form of physical violence by an intimate partner within their lifetime.

But what does it have to do with animals?

Pet ownership has consistently increased in the United States over the past few decades.  An extensive study in 2016 found that 68% of all U.S. households included at least one pet.  These pets are increasingly identified as family members and provide important emotional support to individuals.  Victims of domestic violence find themselves isolated and alone; therefore, relying more heavily on the support they receive from their pets, which can ultimately endanger these animals.  Studies have indicated a correlation between domestic violence and child and animal abuse. In other words, a person who abuses a partner is more likely to also abuse children and animals within the home.  A study of women in domestic violence shelters found that 71% reported that their batterers had harmed, killed or threatened animals in order to coerce, control, or humiliate them.  And additionally, multiple studies have found that women delay leaving abusive situations and/or seeking help out of concern for their animal.  Indicating a potential gap in services and a need for more assistance to victims of abuse who have a pet.

Domestic violence shelters and service providers are developing resources to assist human and pet survivors.  Domestic violence shelters, with the help of grants from entities such as the AKC Humane Fund, RedRover, and Sheltering Animals and Families Together (SAF-T) are expanding services to include housing for animals along with survivors of abuse.  Therefore, shelters across the United States are developing and increasing their services for this population of victims seeking assistance through offering resources to help both individuals and their pets.  States across the U.S. have also developed new legislation that include pets on protective orders as well as increased penalties for various forms of abuse and neglect of animals, which can help domestic violence survivors with pets.  Service providers in the U.S. are increasing their awareness of these individuals and their unique obstacles and needs.

How to Help:

As many know, safety planning is essential in assisting individuals experiencing domestic violence; however, safety planning that includes pets is limited.  Safety planning involves creating a realistic plan for safety, allowing victims to evaluate their home, or the physical space around them, and abusive situation with more focus on personal safety.  Safety plans also provide direction and resources.  Direction includes personal items to be easily accessible in case an emergency evacuation is necessary. These items can include having a bag containing a few days clothing and personal affects in a discrete but convenient location, along with compiling a collection of important personal documents kept together to grab in a hurry, if necessary.  A safety plan including pets may direct individuals to compile animal needs in one central location to be easily grabbed in instances of expedited departure.  These items to put together include veterinary or vaccination records, medication, collar, leash, pet carrier, food, and other items that may be needed to care for the animal.  Safety plans can provide victims with ideas of how to decrease their potential for injury but also reassurance that in case of an emergency there is a plan to follow that may provide additional safety when exiting an abusive relationship.  This is highly important because it has been well documented that the most dangerous and potentially lethal, time for victims of domestic violence is in their exit of an abusive relationship.

Victims and survivors of domestic violence may not accept help until they are ready; therefore, if an individual confides in you and is seeking help, it is important that you squelch your personal perception and biases.  Helping an individual may include listening non-judgmentally, providing support, and/or connecting the survivor with resources.  Domestic violence shelters across the U.S. provide counselling services, legal assistance, shelter, and other pertinent resources for little to no cost to survivors.  Service providers to these survivors can enhance the pet safety; therefore, the victim's connection to these resources can save lives.
If interested in learning more about abusive relationships, ways to help, or if you encounter someone seeking assistance, the following resources can provide vital information.

The National Domestic Violence Hotline (1-800-799-7233 or 1-800-799-SAFE) connects individuals with their local resources, including animal friendly shelters both via phone and through their website (  The website has extensive information regarding safety planning with or without pets, how to identify abuse, advice on helping others, and much more.

Women's Law Organization ( provides statutory legal information for victims pertaining to restraining orders, custody, divorce, immigration, and other matters that may be encountered.

In all, it is important to recognize that we all can play a part when it comes to human and animal safety.  We must be aware that this is a prevalent issue across the U.S., including your neighborhood.  Being educated and able to respond with relevant information will help when you, a loved one, colleague, friend, neighbor, or patient displays a need for help. 
October is Domestic Violence Awareness Month, this is a good time to reach out to shelters in your area and volunteer, or just get to know what service your community offers to people and their pets!
Sandra S. Brackenridge, LCSW, BCD
Each year, the Texas Chapter of the National Association of Social Workers selects a social worker for this award to celebrate a lifetime of  accomplishments.   In honoring the Lifetime Achievement Award winner, NASW/Texas recognizes the best social work values and accomplishments demonstrated throughout the social workers lifetime.  Recipients of the Lifetime Achievement Awards demonstrate repeated outstanding achievements, make contributions of lasting impact, exemplify outstanding creativity, and receive recognition beyond the social work profession.

Sandra Brackenridge, LCSW, BCD, is the 2018 recipient of the NASW/Texas Social Worker Lifetime Achievement Award.  Sandra is private practice clinical social worker, who provides clinical supervision to approximately 25-30 Master Level Social Workers working towards LCSW.  She is also a Veterinary Social Worker and a field instructor at the Center for Veterinary Specialty + Emergency Care, a self-employed Veterinary Social Work Program Consultant, and an affiliate faculty at University of Tennessee Veterinary Social Work Certificate Program.  This year, Sandra retired as a Tenured Associate Professor of Social Work at Texas Women's University.

At TWU, Sandra held a multitude of positions, ranging from serving on the Undergraduate Council and Academic Success Subcommittee to the Social Work Program Faculty Search Committees.  She was awarded Texas Women's University Faculty Advisor of the Year and TWU Favorite Faculty.  Sandra introduced a well-received elective on grieving and created a field practicum placement in veterinary clinics for social work students.  Sandra has many chapters, journal articles, and books to credit her literary contribution to the field of social work.  In addition, Sandra is highly admired and respected for the guidance and professional development she provides to so many social workers seeking clinical supervision while working torwards their LCSW.

Sandra has been a tireless pioneer for the field of Veterinary Social Work.  As the previous Coordinator of Counseling Services at the School of Veterinary Medicine at Louisiana State University to a Veterinary Social Work Program Consultant, she continues to leave and impactful legacy in this specialty of the social work field.

Her years of experience and compassion have left a lasting effect on the personal lives of those she supervises and improved the quality of clinical care provided by social workers.  Sandra's contributions to the social work field will have a lasting impact, and can be examples of aspirations to other professionals within our field.  Through Sandra's creativity, advocacy, and professionalism she uniquely fostered a sought after presence within the community, and those she serves.  Sandra has provided academic teaching to hundreds of students who now possess licenses across the United States.  Additionally, Sandra provides supervision to those wishing to fulfill the requirements for full licensure.  The clinical coaching provided by Sandra in these supervision sessions are actively saving lives within our community.

Sandra continues to demonstrate an exceptional ability to advocate for social work values, displays unparalleled leadership, and advances the social work profession in a multitude of ways.  The contributions to the social work field Sandra has made will continue to edify, shape, and support not only our profession, but the community in which she serves, for many years to come.

NASW-Texas is proud to recognize Sandra Brackenridge, a nationally recognized practitioner, educator, and scholar, to celebrate her lifetime achievements as a leader, advocate, and champion in the field of Veterinary Social Work!

Nominated by the Texoma Branch
Copyright © 2019 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:
Center for Veterinary Specialty + Emergency Care
2700 Lake Vista Drive
Lewisville, TX 75067

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The Referral Pearl
Volume 4. Issue 3

March 2018


CVSEC 2018 Discussion Series

CVSEC Veterinary Social Worker, Sandra Brackenridge, is again offering a series of discussions pertaining to the health and wellness of those in veterinary practice.  The discussions begin on March 27, 2018 at 6:00 PM at CVSEC and will continue for 6 weeks.  Sandra is a licensed clinical social worker who has worked with veterinary professionals for many years, and she speaks regularly on these topics. 

We would like to welcome your staff to attend these 1 hour discussions, as your staff may find them highly beneficial as well.  Please feel free to post the flyer in your practice.



Presented by Sandra Brackenridge, LCSW, VSW

Tuesday April 3: “Alleviation of Stressors and the Resilient Lifestyle: Tips on Nutrition, Exercise, Sleep, Supplements, etc.”
Tuesday April 10: “Boosting Resilience Resistance to CF and Burnout: Mindfulness and other EASY techniques”
Dr. Ducote' will teach the technique of Mindfulness
Tuesday April 17: “Enhancing Communication in Working with Clients and Co-Workers: Body Language, Tone, Verbal Phrasing, etc.”

Tuesday April 24:Client Types: Preparing for the Types and Satisfying Even the Angry Client”

Tuesday May 1: “The Moral Stress of Practicing in VetMed and Shedding those Negative Inner Dialogues”

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Referral Pearl                                                   
Volume 4. Issue 2

February 2018                                          
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Our Neurology Service at the Center for Veterinary Specialty + Emergency Care is comprised of experienced Board Certified Neurologists, Neurology Residents / Interns, and a compassionate support Staff who work closely with our other Specialists and ER Doctors to provide exceptional Patient care.  When preparing a referral to our Neurology Service for your Patients, please consider the following:

  • All Neurological Patients receive a comprehensive neurological exam to determine the correct diagnostic option - an MRI or CT/myelogram.
  • At CVSEC we have a Collaborative Team of on-site Doctors.  During non-peak hours (weekends and after 4:00 pm Monday - Friday), our Neurosurgeons are available to consult remotely with our Emergency and Critical Care Team (E/CC) and to perform neurosurgery on an emergency basis (if needed).
  • We have the capability to evaluate cerebrospinal fluid (CSF) on site.
  • We do pre-anesthetic baseline blood-work screening and chest radiographs in Patients over six years of age to rule out other abnormalities.
  • We always use the safest intravenous and inhalant anesthetic medications, such as Alfaxan and Sevoflurane.
  • Evaluation by a Neurologist prior to MRI ensures that the correct neuroanatomical location is imaged, and that your Client and Patient will receive the best recommendations for treatment options.

  • We provide MRI services in collaboration with Animal Imaging.  One of our Neurologists will assess the Patient to ensure that the Pet is safe for MRI and anesthesia prior to transport to Animal Imaging.  Our Neurologists interpret the MRI in conjunction with Board Certified Radiologists (
  • MRI machines vary in quality.  CVSEC provides 3T MRI in collaboration with Animal Imaging which yields the highest quality diagnostic images available.
  • MRI results are usually available within 24 hours.
  • There are onsite MRIs that may be able to offer a faster appointment, however, faster is not always better.  If the diagnostic quality of the images is poor, there may be no benefit to the Patient.
  • Radiologists will often call to address other problems that are found by the MRI such as incidental masses.  We can then work with our Internal Medicine Team to have them evaluated for continued care.
  • Our Patients are monitored overnight after the MRI to make sure that there are no post-anesthetic complications, and intravenous fluid support is provided to protect the Patient's kidneys since contrast is used during an MRI.

  • 100% of our Neurosurgeries are performed by Doctors who are specifically trained in Neurosurgery.
  • We have two dedicated Nurses assigned to a Patient while in the O.R.
  • We have Board Certified Criticalists on staff who are available if an issue with anesthesia occurs during surgery. 
  • Our Hospital has Doctors and Staff who are trained in ventilator therapy (if needed).

  • We provide superior aftercare:  Patients are hospitalized until Clients are comfortable taking their Pet home.  Until then, physical therapy is done multiple times a day in Hospital which includes laser therapy, cold/warm packs, Passive Range of Motion (PROM) exercises, massage, and standing exercises.
  • We have Doctors present 24/7, and our overnight Doctors always assess post-surgical Patients to confirm they are recovering well.  Our Neurologists are updated whenever necessary, ensuring the best outcome.
  • Staple removal and one month post-op assessment are complimentary.
  • Our Collaborative Team takes care of your Patient, so you can get a good night's sleep.
  • Our dedicated ICU Team is always available to update your Clients on how their Pets are doing overnight.
 (Dr. Hollman pictured with three of her Patients - Natasha, Boris and Nellie Price)

Copyright © 2018 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:
Center for Veterinary Specialty + Emergency Care
2700 Lake Vista Drive
Lewisville, TX 75067

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Referral Pearl
Volume 4. Issue 1


January 2018

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Canine Liver Enzymes:  Choosing the Right Path for Diagnosis

Valerie Case, DVM
Diplomate ACVIM - Internal Medicine

Interpreting canine liver enzymes can be very challenging.  Reversible but severe elevations can occur with administration of certain drugs, while diffuse neoplasia may be present in the liver without causing any enzyme changes.  This article summarizes the guidelines our Internal Medicine Department uses to evaluate canine liver enzymes.

Alkaline phosphatase (ALP) has high sensitivity but low specificity for hepatobiliary disease.  Elevation of ALP alone without other enzyme abnormalities is most often associated with drug induction, hyperadrenocorticism, and benign reactive changes within the liver including nodular hyperplasia and vacuolar hepatopathy. Occasionally ALP is the only abnormal enzyme in Patients with hepatic neoplasia.  If a Patient's history does not support exposure to ALP inducing drugs or endocrine disease, monitoring the ALP over time is an acceptable course of action in asymptomatic Patients.  If the ALP elevation persists or is progressive over 4-6 weeks, abdominal ultrasound and liver function testing is recommended for further investigation.  Our on-site laboratory can measure both serum bile acids and blood ammonia levels.

Gamma glutamyl transferase (GGT) has greater specificity for hepatobiliary disease compared to ALP.  When both GGT and ALP are elevated, the specificity for liver disease nears 100%.  Gall bladder and bile duct disease will cause the largest elevations in GGT.  The combination of increased GGT, ALP, total bilirubin, and cholesterol should be immediately concerning for biliary tract obstruction, and warrants referral for abdominal ultrasound and critical care management.

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase due to leakage from damaged hepatocytes.  Mild elevations can occur with diseases outside of the liver including pancreatitis, gastroenteritis, congestive heart failure, and endocrine diseases.  Toxic and infectious hepatitis generally cause the largest elevations of ALT and AST due to widespread hepatocyte inflammation and necrosis.  A thorough history exploring risk of exposure to known hepatotoxins as well as testing for Leptospirosis are indicated in these cases.  AST elevation exceeding ALT may indicate muscle cell damage rather than liver disease.  Evaluation of creatine kinase (CK) can help to differentiate.

Abdominal radiographs are excellent for evaluating hepatic size and screening for mineralization or gas within the parenchyma or biliary tree.  Abdominal ultrasound can determine if disease is focal or diffuse, as well as evaluate the biliary system and portal vasculature.  In some cases extrahepatic portosystemic shunts can be visualized, but should always be confirmed with portal scintigraphy.  Fine needle aspiration can be diagnostic when focal lesions are present, or when the liver is enlarged with diffuse parenchymal changes (hepatic lipidosis, lymphoma).  Patients with suspected chronic or chronic active hepatitis require liver biopsy for definitive diagnosis.  Biopsies obtained via laparotomy or laparoscopy are recommended over ultrasound guided techniques.  We offer laparoscopic liver biopsy for Patients over 20 pounds body weight.

Our Internal Medicine Team is proud to offer extensive diagnostic testing and care for your Patients with hepatic disease.  Call our Client Service Representatives today to schedule your Patients (972.820.7099)!



CVSEC is proud to introduce our newest member of the IM Team!

Teresa Seyfert, DVM
Diplomate ACVIM - Internal Medicine


Dr.Teresa Seyfert grew up in Iowa and Kansas and received her DVM from Kansas State University in 2005.  She completed a rotating small animal surgery and medicine internship at The Ohio State University and then an Internal Medicine internship and residency at Oklahoma State University.  She became board certified in Small Animal Internal Medicine by the American College of Veterinary Internal Medicine in 2012.  Dr. Seyfert worked at private specialty practices in Wichita, KS (2011-2015) and Grayslake, IL (2015-2017) prior to joining CVSEC in 2017.

Dr. Seyfert's professional interests include hematology/immunology, infectious disease, and minimally invasive diagnostic procedures.

When not at work, Dr. Seyfert enjoys spending time with her husband, daughter, and 2 dogs.  She likes to watch movies, read for fun, and travel to enjoy sporting events, concerts, and amusement parks.  She is also trying to learn more about cooking.

Dr. Seyfert can be reached at 972.820.7099 or  She is looking forward to meeting our Referring Community and partnering with you in Patient care.




Copyright © 2018 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067

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Referral Pearl

Volume 3. Issue 6 

October 2017

CVSEC Veterinary Social Workers Discussion Series 2017


The Veterinary Social Workers at CVSEC will be hosting a series of presentations at our Hospital over the next four weeks.  The topics of interest were based on an internal survey that the Team recently participated in.  We would like to invite members of our Referring Community to attend any of the sessions.  The schedule is provided below and 2:00 pm to 3:00 pm will be the time for all presentations:

Thursday, November 2nd:  "Communication to Enhance Work with Clients and Co-Workers:  It's all in how you say it"

Thursday, November 9th:  "Boosting Resilience and Resistance to CF and Burnout:  Mindfulness and other EASY techniques"

(Dr. Ducote' will teach the technique of Mindfulness)

Thursday, November 16th:  "Client Types:  Preparing for the Types and Satisfying Even the Angry Client"

Thursday, November 30th:  "Stop Eating/Beating Yourself Up:  Shedding Negative Inner Dialogues and the Moral Stress of Practicing in Vet Med"

Kendall Day, DVM
Neuro Intern

Dr. Kendall Day is originally from upstate New York.  She obtained a BS in Marine Biology from the University of Rhode Island in 2011.  She then worked as a Veterinary Technician for one year before she got sick of the cold weather and decided to travel to the south for veterinary school.

She attended Auburn University College of Veterinary Medicine and graduated in 2016.  She then moved to Tampa, Florida for a one year rotating internship at Blue Pearl Veterinary Partners.  She recently moved to Dallas, Texas with her boyfriend and their two mixed breed dogs, Callie (Australian shepherd mix) and Lexie (Boxer mix) for a one year Neurology specialty internship at CVSEC.

Her love of Neurology began after adopting a sweet golden retriever named Molly with idiopathic epilepsy.  The fascination continued throughout veterinary school where she decided to pursue a career as a Neurologist.  In her free time, you can find her at the gym, hiking outside with her dogs or roasting her own coffee beans.
Super cute Hotdog and Bubble Bee!

The Poop Machine
Go Cowboys!

CVSEC is a Teaching Hospital

Center for Veterinary Specialty and Emergency Care is dedicated to compassionate care of our Patients.  We are also committed to the education of our future veterinary colleagues.  CVSEC is the only Specialty and Emergency Hospital in North Texas that has two ACVIM approved residency programs:  one in Internal Medicine and one in Neurology.  Currently, we train three residents:  Dr. Stikeman in Internal Medicine and Drs. Williams and Lindsay in Neurology.  All three residents are licensed veterinarians that have extensive specialized training prior to starting their residencies including rotating general medicine and surgery internships as well as one or more specialty internships in their respected field.

Speaking of specialty internships, CVSEC offers three specialized internships in Emergency and Critical Care, Neurology, and Internal Medicine.  Specialty interns work side by side with our Specialists and Emergency Doctors to provide
comprehensive care for our Patients and direct communication with our Clients.  Many of our specialty interns have moved on and become Boarded Specialists across the country.  Both our residents and specialty interns also provide further training to our Hospital Staff through topic presentations and help our Hospital stay up to date on the most current veterinary research by focused journal clubs and topic rounds.

We also train fourth year veterinary students through mentored externships in Neurology, Internal Medicine and Emergency and Critical Care. This is an amazing opportunity for our future colleagues to experience specialty and emergency care in a busy
private practice setting before graduating from their respective veterinary programs.

If you have questions about the residency, internship, and externship opportunities at CVSEC, please contact our House Officer Lead, Dr. Susan Hollman at

Barbara Lindsay, BSc, BVMS

Dr. Barbara Lindsay grew up on a sheep farm in south-east Australia.  She moved to Perth in Western Australia to attend Murdoch University for her veterinary training (which is an American Veterinary Medical Association accredited school).   She has completed a Surgical internship in Sydney and a Neurological internship in New York before relocating to Dallas to pursue further study in Neurology.

Dr. Lindsay enjoys Barre Pilates, jogging, and expresso coffee.  Whist she misses her sheep dogs back on the farm "down under" she is having a fantastic time exploring the Lone Star State and meeting the locals!

Dr. Lindsay Patient - Archie Silverman
Happy Halloween from the Whataburger Family!
Cookie Monster




Copyright © 2017 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067


Referral Pearl
Volume 3. Issue 5

September 2017

CVSEC would like to thank our current Top Referring Facilities!  Thank you for your partnership with us!! 

Hillside Veterinary Clinic

Animal Clinic of Farmers Branch

VCA Metroplex Animal Hospital

River Chase Animal Hospital

Banfield - Lewisville

Katy Trail Animal Hospital

Legacy Veterinarian Hospital

All Care Veterinary Hospital

Vestsavers Pet Hospital

Community Pet Outreach

Banfield - West Plano

Stonebriar Veterinary Centre

VCA Angel Vet Center Flower Mound

All Creatures Veterinary Center

North Dallas Veterinary Hospital

Creekside Pet Care Center

I-20 Animal Medical Center

ADC - Dallas

Healthy Paws Veterinary Center

Country Creek Animal Hospital

Animal Emergency Hospital of North Texas

Hebron Parkway Veterinary Hospital

Animal Medical Center of Plano

Valley Ranch Pet Clinic

Allen Veterinary Hospital


Tyson's Story
Tyson presented to CVSEC on 8.28 .17 for upper airway obstruction.  His family was being evacuated from Houston as Hurricane Harvey approached and on the trip, Tyson got worked up and obstructed his airway.  He was sedated and emergently intubated; his soft palate was very long and his laryngeal tissues were swollen and erythematous.  After 36 hours, we tried to extubate him, but were unsuccessful. 

We partnered with Dr. Corbin at VCA Metroplex and she performed brachycephalic airway surgery.  The CVSEC Critical Care Team continued care after surgery, keeping Tyson intubated to allow his airway to heal and swelling to resolve.  We again attempted extubation, and again were unsuccessful.  We partnered with Dr. Corbin again, and she performed a tie back on the right side of the larynx.  She also performed a temporary tracheostomy to limit air movement through the upper airway.

Tyson was maintained with sedatives, and NG tube, IV fluids, and over the subsequent days, his upper airway started to heal.  On Saturday, the temporary trach tube was removed and Tyson's treatments were continued.  He was discharged on Wednesday, September 13th to head back to Cypress with his family.  Tyson was with us for 17 days. His family brought the RV so that Tyson could travel with great comfort and relaxation!

Dr. Heather Rhoden
Emergency / Critical Care

Dr. Rhoden grew up in a small town in Nebraska and always knew she wanted to be a Veterinarian.  In 2014 she received her DVM degree from Oklahoma State University.  She spent the following year working as a Veterinary Intern Instructor at Texas A&M University, training in Emergency and Specialty Medicine and teaching Veterinary students.

After her internship, she spent 8 months working as a General Practitioner and quickly realized that she missed Emergency Medicine.  Dr. Rhoden joined the Team at CVSEC in March of 2016.  She enjoys the challenge of Emergency Medicine in a Specialty Practice and loves that her colleagues are willing to teach and learn new things.

When not at work, Dr. Rhoden can be found in the garden or working on home improvement projects with her husband, Gene.  She also enjoys crafting and spending time with her furry and feathered family members.
Dr. Ragan Vadell
Emergency / Critical Care

Reagen Vadell is a graduate of Texas A&M University.  She was born in San Antonio but made a detour through Portland, OR, and Seattle, WA, before settling in Midlothian, a small town south of the Metroplex.  She considers College Station home as she got both her undergraduate and Doctor of Veterinay Medicine degrees at A&M.  She worked at a few mixed animal practices treating dogs, cats, cattle, sheep, goats and horses before joining CVSEC.

When not working or learning more about vet med, she's passionate about traveling, reading, trying new activities and foods, playing with her horses, and spending time with her husband and three mutt dogs - Belle (a heeler cross), Rich (a Black and Tan coonhound mix) and Deuce (a German shorthair pointer cross).
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Referral Pearl
Volume 3. Issue 3

June 2017
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Why Veterinary professionals rank highly among professions at risk of suicide is an engaging topic for discussion and for further research.  However, reality hit the DFW veterinary community hard in May 2017 when we experienced four suicides in our area.  When there is one suicide, there may be others, because for every suicide completed 6-7 individuals are at risk for suicide.  All who knew the person may have long-lasting psychological and/or existential issues related to that type of loss.  Grief due to suicide is complicated, unique, excruciating, and some survivors may not ever heal completely.  For the DFW veterinary community, action is needed NOW for prevention of more suicides.

I've been around your profession for a long time, and more information can be found at  I care a lot about your well-being, and I hope to help prevent suicide in your community.  I've been supervising a Veterinary Social Work Internship at the Center for Veterinary Specialty + Emergency Care for several years now, and former interns are now licensed and ready to help you and your staff.  Some of them contract with me in my private practice, and others are referral sources.  We are uniquely qualified to offer counseling and other services to you and your staff, because we know a little about your profession, your personalities, and your stressors.  Recently, I've become a part-time employee at CVSEC, continuing the internship program as well as providing staff support and intervention.  Veterinary Social Work is not a specialty of CVSEC to which you can refer, but you may contact me for services through my website or by phone.

So most importantly, how does one prevent suicide if you're co-worker, boss, friend, or other peripheral person?

Recognize the clues:
  • Direct or Indirect Verbal Clues:
    • Direct:  I want to kill myself.  I wish I were dead.
    • Indirect:  You won't see me again.  I want to go home.  I am done.
  • Situational Clues:
    • Other losses recently...humans, pets, therapists...
    • Break ups in a relationship or divorce
    • Loss of freedom
    • Unexpected financial difficulty
    • Unwanted relocation
  • Behavioral Clues:
    • Marked changes in behavior
    • Newly interested in religion or disinterest when formerly religious
    • Giving precious things away
    • Making arrangements for children or PETS
    • Gong to the doctor (hoping to feel better)
    • Relapse into drug or alcohol abuse (If drinking or abusing other substances, the risk is substantially higher)
    • Buying a gun with no reason for it
    • Making wills and body disposition arrangements
    • Saying goodbye in a creepy, permanent way
Ask the question:

  • I wonder if you're thinking of suicide?
  • I'm concerned that you may be considering suicide.
  • Given what you're feeling/going through/telling me, I need to ask if you're suicidal.

Persuade them to see or talk to a qualified counselor:

THE MOST COMMON EMOTIONAL STATE OF SOMEONE SUICIDAL IS AMBIVALENCE AND HOPELESSNESS.  This means they would choose life if they could have hope that life and their emotional state would get  better.  Sometimes you might give them that hope.  TELL THEM THAT THEY DON'T HAVE TO FEEL THIS WAY FOREVER, and know that they really don't.  There are other solutions, and a qualified counselor must help find those solutions with them.


Call 911 and ask them to make a welfare check if you're worried and unable to contact the person.

Call 911 if the person has a plan, has a readily available weapon, and the person refuses to seek counseling help.

Sandra Brackenridge, LCSW
208.705.0088 Cell


(No RSVP necessary / No cost)


The Center for Veterinary Specialty + Emergency Care is excited to announce that we will be participating in a multi-center clinical trial evaluating a new treatment of acute pancreatitis in Client-owned dogs. 

For more information, or if you think you have a Patient that qualifies, please contact Jen Mahon, DVM DACVECC at 972.820.7099.


We LOVE our Patients as much as they LOVE us!



Our experienced Internal Medicine Team is skilled in the diagnosis and management of acquired cardiac diseases common in your canine and feline Patients.  We also provide the added benefit of extensive experience in managing Patients with concurrent cardiac and extra-cardiac disease.  

Services offered:

  • Echocardiography
  • ECGs / Holter monitoring
  • Doppler blood pressure assessment
  • 24/7 intensive care and monitoring for critical cardiac Patients (part of our continuous "Collaborative Care")

Our training is best suited for Patients over 2 years of age, as we do not perform interventional procedures that many congenital defects require.

Please call our Client Service Representatives today to schedule your Patients!




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Referral Pearl
Volume 3.  Issue 2

May 2017

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CVSEC Launches New Website - April 2017

We hope you check out our newly renovated website.  We are continually adding and updating the content to keep it fresh and interesting.  A few tools that you or your Clients may be interested in utilizing:

  • Patient Referral on-line form
  • RDVM Survey
  • FAQ's (updated)
  • Resource section with available links
  • Request for Marketing materials can be sent via the website (brochures, magnets, business cards, referral pads, etc.)
  • Medical Resource Library
  • ER Pre-Registration form
  • New Patient Registration form
  • Prescription Request form
  • Care Credit on-line application for your Clients
  • Client Survey

Please give us your feedback and let us know if there are any items that would be useful to you.  We are continuously looking for ways to enhance and improve the referring process.


As always... thank you for your continued referrals!!! 

Shelley Martin and the CVSEC Team


Benjamin Williams, DVM, MS
Neurology / Neurosurgery


Dr. Williams graduated from the College of Veterinary Medicine at Western University of Health and Sciences in California 2014.  He completed a 1 year internship in Small Animal Medicine and Surgery at Angell Animal Medical Center in Boston, MA. 

Following that he relocated to Texas to accept a Neurology Specialty Internship position at CVSEC.  Since completing the Specialty Internship in 2016, he has remained at CVSEC and started a 3 year Residency program in Neurology and Neurosurgery.

In his free time outside the Hospital he enjoys reading, hiking, fishing, and watching most sports (football in particular).  Having grown up with Irish Setters, he has a fondness for the breed, but currently shares an apartment with one adopted cat.


Dr. Williams Presenting To The Team

CVSEC Neuro Technicians

Kimberly Claus, DVM
Practice Limited to Emergency and Critical Care

Dr. Claus earned her Doctorate of Veterinary Medicine from Oklahoma State University in 2007.  After graduation, she practiced for 3 years at a Dallas emergency animal hospital. 

Dr. Claus especially loved critical cases and pursued additional training in that area.  She completed a 3 year residency program in  Emergency and Critical Care at the University of Wisconsin-Madison, then came bak to DFW again.  Dr. Claus is proud to have joined the CVSEC family in 2016.

Her professional interests include sepsis, acute abdominal diseases, shock resuscitation, cardiovascular emergency stabilization, and neurologic emergencies.

In her spare time, Dr. Claus enjoys live music, art, wine, traveling (especially to colder climates), and spending time with friends and family.  She has a soft spot for great danes and currently has a deaf, poorly visual white dane, whose antics and goofiness make her laugh every day!


Dr. Claus and Dr.
Williams in the E/CC Area of CVSEC



Referral Pearl

Volume 3. Issue 1






Lunch and Learns with A CVSEC Specialist!


The Center for Veterinary Specialty + Emergency Care is proud to announce that we are taking our 2017 "PAWS4CE Series" on the road visiting our Referring Community!  Our first CE was held at Legacy Veterinary Hospital in Frisco on Tuesday, April 4th.

Dr. Kent Julius chose the topics of discussion and two of our CVSEC Specialists, Dr. Jen Mahon and Dr. Eloise Stikeman presented to his Team.

Dr. Mahon:  "Initial Stabilization of the Thoracic Trauma - or any Trauma Patient"

Dr. Mahon:  "Using the Ultrasound Probe In Patient Assessment - i.e. Fast Scan"

Dr. Stikeman: "Use of Budesonide in Inflammatory Bowel Disease (IBD), Dosing and Usage, Systemic Effects, and Current Case Study Underway at CVSEC."

*** Please contact Shelley Martin at or 972.820.7099 to schedule a "Lunch and Learn" with one of our CVSEC Specialists.  We would love to come and visit your facility and meet your Team!

Dr. Mahon presenting to the Team at Legacy Veterinary Hospital - Frisco.


"Thank you CVSEC for coming out and presenting such an in-depth "Lunch and Learn" at my hospital!  It was much more than any of us expected.  I really appreciate your Specialists being available for the topics of our choice AND for spending as much time as needed for all of our questions.  We will be happy to schedule the next one!" 

Dr. Kent Julius

Legacy Hospital was founded by Dr. Kent Julius is 2003.  He opened a 2,000 sq. ft. shopping center at the corner of Lebanon and Legacy.  At that time he did not offer grooming and had very limited boarding.  Over the next 5 years, Legacy grew from 4 employees and 1 Veterinarian to 11 employees and 2 full-time Veterinarians!  In the winter of 2008 the Team at Legacy moved into their current 6,000 sq. ft. facility.  There are currently over 20 employees and 5 Doctors on staff at their beautiful hospital! 

"Since opening in 2003 our focus has remained on the best possible patient care and customer service.  We like to provide our patients and clients a high quality veterinary service in a friendly, unique, clean and organized setting."




Jen Mahon

Diplomate, American College of Veterinary Emergency & Critical Care Medicine

Dr. Jen Mahon completed veterinary school at Tufts University Cummings School of Veterinary Medicine in 2012, and completed a one year internship in Albuquerque, NM.  She returned to Tufts for a three year residency in Emergency and Critical Care, and achieved Board Certification in the American College of Veterinary Emergency and Critical Care in 2016.

Prior to being a Veterinarian, she worked as a Veterinary Technician in Pennsylvania, Massachusetts, and Texas.  While working as a Technician, Emergency and Critical Care captured her heart and mind and hasn't let go since. Her favorite Patients are the sickest ones, and getting them well enough go home is her goal.  She loves to treat sepsis, trauma, multi-organ disease, and has a special interest in mechanical ventilation for dogs and cats.

In her spare time Dr. Mahon loves to do yoga, bike ride, and knit, but not all at once. She enjoys spending time with her partner and their three cats and exploring all that Dallas has to offer.


Anaphylactic Shock (Apollo's Story)

Apollo is an approximately 2 year old pit bull who was adopted about 2 months ago by a family that found him wandering the woods behind their home.  They brought him to the Allen shelter to see if anyone would claim him, and after 5 days, he was released to their care and Apollo went to his new amazing home! 

On March 20th, Apollo suddenly vomited and collapsed outside.  He was brought to his Primary Care Veterinarian, McKinney Animal Hospital (Dr. Ewa Cissik).  Blood work showed that Apollo could not clot his blood, and one of his liver values was high, suggesting anaphylaxis.  They placed an IV catheter and gave him an injection of epinephrine, and referred him to CVSEC

On presentation to CVSEC, Apollo was in shock- he was weak, with a high heart rate and thread pulses, all classic signs of shock.  We started him on IV fluids to treat shock, and started to thaw frozen plasma to replenish clotting proteins.  We also ran some diagnostics, and one of the key diagnostics was an AFAST.
AFAST stands for "abdominal focused assessment for trauma and shock.  It is a type of ultrasound, or sonogram, which is performed within 2 minutes.  It's not a comprehensive, organ-by-organ test; rather, it looks at a few key areas of the abdomen to allow for rapid assessment and treatment. The striking findings for Apollo were that he had a small amount of fluid collected in his belly, and his gall bladder bore what is called a "halo sign".  The halo sign is a bright ring of fluid, and can serve as a marker of anaphylactic shock. 

Anaphylactic shock is seen with some frequency in our ER, about 1 case every week or two, and is more common in dogs than in cats.  The causes of anaphylaxis can vary from a bee sting to a plant to a drug, but in most cases, the trigger is never identified.  Anaphylaxis differs from a typical allergic reaction in a few ways.  First, in anaphylaxis, shock and collapse are hallmarks, and vomiting or diarrhea is very common.  In an allergic reaction, usually facial swelling or hives are seen on a dog that is still wagging its tail and acting very normal.  Second, the way anaphylaxis is generated in the body is different at the cellular level than an allergic reaction as well, which may explain the difference in the way the two processes appear.  And third, the treatment is vastly different.  Dogs with allergic reactions are usually treated with an antihistamine and maybe a steroid and discharged within an hour or two (the exception to this is if hives develop in the throat, constricting the airway- that is an emergency!).  Patients with anaphylaxis are usually hospitalized for days; require intensive care and monitoring, IV fluids, transfusions, and IV drips of epinephrine (adrenaline) to keep them alive.  Anaphylaxis is survivable, but the best outcomes result from prompt Veterinary attention.  Fortunately for Apollo, he collapsed right in front of his family, so they were able to respond quickly and appropriately. 

Apollo spent 3 days in the Hospital, received three transfusions of plasma, and a lot of medications.  After about 12 hours of treatment, he started to eat and drink.  On his last day of hospitalization, he was off all IV medications, and went home to his family that evening. 

Apollo's story is a success for three reasons:

1. His family had an appropriate and rapid response to his development of shock.

2. His Primary Care Vet, Dr. Cissik, treated him appropriately prior to referral.

3. The CVSEC team is very familiar with the treatment of anaphylaxis and we know that in order to get Patients through, we have to act aggressively. 

By:  Dr. Jen Mahon




Internal Medicine
Budesonide Case Study Reminder

  • Study purpose:  To investigate the long-term effects of a locally acting enteric steroid (budesonide) on proteinuria
  • Hypothesis:  Long-term use of budesonide will result in significant proteinuria
  • Inclusion Criteria:  Dogs with IBD initiating therapy with budesonide

We are looking for Pets with chronic gastrointestinal disease to participate in a study investigating the proteinuric effects of budesonide.  Patients will undergo endoscopic biopsies and treatment for IBD with parallel observations of proteinuria over the duration of treatment.


What Benefits are Procured to the Client?

  • In addition to a comprehensive work up and treatment for the chronic enteropathy, Patients who qualify for study enrollment will receive:

A large discount on the endoscopy procedure and histopathology of the GI tract

Complimentary budesonide medication for the duration of the three month study period

Complimentary food as indicated for the Patient at the start of the study

If you are interested in this case study, please contact Dr. Eloise Stikeman at or 972.820.7099.





Copyright © 2017 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of or Top Referring Facilities, you have been included on our monthly newsletter mailing list - The Referral Pearl."

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Lewisville, TX 75067

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Referral Pearl
Volume 2. Issue 8

August 2016



Research at CVSEC:  Influence of Budesonide of Proteinuria on Dogs with IBD

In the management of inflammatory bowel disease and related conditions such as protein-losing enteropathies, corticosteroids remain the cornerstone of therapy to control inflammation and resulting clinical signs.  The chronic nature of the disease most often necessitates long-term use of steroids which poses risk of causing significant side effects over time.  In recent years there has been an increasing appeal to utilize budesonide in the treatment of chronic inflammatory gastrointestinal disease due its preferentially localized effects within the gastrointestinal tract.  This focused therapy is the result of the drug being poorly absorbed through the enteric mucosa and undergoing extensive first-pass hepatic metabolism thereby limiting its greatest influence to the intestinal wall.  In human patients, these unique properties of budesonide result in limited systemic side effects but this has not been replicated in the literature pertaining to canine patients.  A recent study demonstrated equivalent frequency of steroid-induced side effects observed in IBD dogs treated with budesonide as with prednisone.  The severity of the effects appeared reduced in those Patients receiving budesonide, however this did not achieve statistical significance.  It has also been demonstrated by numerous authors that budesonide is capable of influencing the hypothalamic-pituitary-adrenal axis resulting in suppression of endogenous steroids with long-term use.

Yet in spite of multiple research papers clearly documenting the systemic effect of budesonide, there remains an allure in its application over prednisone, particularly in Patients in whom a more systemic steroid might be contraindicated or of higher risk.  The classic example would be a diabetic dog who risks deregulation of glycemic control on prednisone or a Patient with congestive heart failure in whom we worry about fluid retention and exacerbation of cardiac disease.  Another realm in which the exertion of steroidal effects is of relevance is in the presence of renal disease.  It has been repeatedly shown that both excessive endogenous steroids (such as manifest in Cushing's disease) and exogenous steroid provision (such as prednisone) are capable of inducing significant proteinuria.  This effect has never been investigated in budesonide, however, thus rendering interpretation of proteinuria in a Patient receiving the medication very difficult.  This is of particular interest in the Soft Coated Wheaton Terrier, the poster-breed for protein-losing enteropathies and one in which a later manifesting protein-losing nephropathy can develop.  If the Patient has been receiving budesonide long-term, will we be able to recognize clinically significant proteinuria and appropriately attribute it to primary renal disease?  Similarly, will we be able to accurately stage a Patient with heartworm disease receiving budesonide who is found to be proteinuric in the pre-treatment evaluation?  Will we be able to have confidence in confining autoimmune dysregulation to the GI tract if we start to see proteinuria, a common marker of immune-mediated glomerulonephritis, in a Patient being treated for IBD with budesonide therapy?

The Internal Medicine Department at CVSEC has launched a new study designed to help answer these types of questions.  Dogs who have been diagnosed with an inflammatory enteropathy will be treated with budesonide and undergo serial urine protein evaluations to investigate if the drug is capable of inducing urinary protein loss over time like its systemically acting counterparts.  In order to interpret the data clearly, Patients will be excluded from the study if they have pre-existing proteinuria or any concurrent illness which may predispose to proteinuria over time (such as systemic hypertension, Lyme disease, or hyperadrenocorticism).  Eligible Patients will undergo a comprehensive gastrointestinal evaluation including endoscopic guided biopsies.  If the histopathology confirms a chronic inflammatory enteropathy, Patients will be treated with budesonide.  Adjunctive therapy (such as dietary manipulation, cyanocobalamin supplementation, or supplemental metronidazole therapy) will be permissible per the needs of the Patient.  In short, they will receive standard of care therapy for a diagnosed chronic inflammatory enteropathy whilst the urine is monitored for the presence of protein over time.

Clients who elect to enroll their Patients in the study will receive a significant discount on the endoscopy and biopsies with Animal Reference Pathology in addition to complimentary budesonide therapy for the duration of the study, courtesy of Pet Health Pharmacy. Any Patient with chronic GI symptoms not currently receiving prednisone may qualify for enrollment.

If you have any Patients that may be eligible, please contact Dr. Eloise Stikeman (estikeman@cvsecvet.comor 972.820.7099).  Or if you simply have questions about the use of budesonide in managing chronic inflammatory enteropathies, please reach out to any Doctor in the Internal Medicine Department or speak with Shelley Martin ( to discuss scheduling a CE Lunch & Learn at your Hospital on the Pearls of Managing IBD:  Budesonide and Beyond!






(972) 395-0786

6:30 PM to 7:00 PM

Meet and Greet  

7:00 PM to 8:00 PM: 



Dr. Karen Felsted


(Race approval pending for 1.0 CE credit.)


8:00 PM to 9:00 PM:



Dr. Eloise Stikeman

(Race approval pending for 1.0 CE credit.)


9:00 PM to 9:40 PM:



Dr. Debra Nossaman

(State approved for 0.5 CE credit.)


We would like to thank the four companies that are sponsoring our event!!



Registration fee:  $25 (Includes dinner, drinks, and door prizes!)

RSVP to Shelley Martin ( by 10.20.16.

Thank you to everyone that attended our CE in April at Maggiano's - Willow Bend.  We enjoyed seeing so many of you at the event.  It was a great success!!!

We are looking forward to seeing you at our 2017 CE functions!




Copyright © 2016 Center for Veterinary Specialty + Emergency Care, All rights reserved. 
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl". 

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

LewisvilleTX 75067

Add us to your address book

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You can update your preferences or unsubscribe from this list

The Referral Pearl
Volume 2. Issue 6

June 2016




When you or a family member are ill, you seek the best medical care available, which often includes referral to Specialists and even travel to advanced care centers.  The same can be true for our Pets.  The Internal Medicine Team at CVSEC stands ready to work with you to diagnose and treat your Patients with complex diseases.

Established in 2009, our team of Board Certified Internal Medicine Specialists has more than 20 years of combined experience improving the lives of dogs and cats suffering from a broad range of illnesses. We are also very proud to be the only hospital in the DFW area with an Internal medicine resident in training, who is a driving force for our team to remain current on the latest research and newly emerging tretment options. When you refer to the Internal Medicine Team at CVSEC, we will join you and your Client in the Triad of Care to provide Patients with specialized diagnostic testing and cutting edge therapeutic care.


In addition to the usual diagnostic tools you expect from an Internal Medicine Service, we also practice cardiology (including echocardiography), medical oncology, and are skilled in laparoscopy.  We have on-site CT enabling access to real-time advanced imaging of our patients.  The Internal Medicine Team at CVSEC is also the only specialty practice in DFW to offer tracheal and urethral stent placement.  Patients requiring hospitalization are provided personalized care in our 24/7 ICU staffed with experienced and compassionate Doctors and Technicians.  Our collaborative team approach to veterinary medicine delivers comprehensive and seamless care for your Patients and the Clients who love them.

If you have further questions about what sets our Internal Medicine Team apart from other hospitals, please feel free to call or come by for a visit and a tour.  We are excited to continue working with you and your clients for years to come. 


Thank you for your support!

Valeria Case, DVM
Diplomate ACVIM


Keven Gulikers, DVM, MS
Diplomate ACVIM


Eloise Stikeman, BVMS, Hons.,BSc


Tracheal Stent Placement


Internal Medicine's PAWS4CE Event







Copyright © 2016 Center for Veterinary Specialty + Emergency Care, All rights reserved.
"As one of our Top Referring Facilities, you have been included on our new monthly newsletter, The Referral Pearl".

Our mailing address is:

Center for Veterinary Specialty + Emergency Care

2700 Lake Vista Drive

Lewisville, TX 75067