Synovial extramedullary hematopoiesis in a dog.

OBJECTIVE: Synovial extramedullary hematopoiesis is a rarely reported condition in humans and, to date, has never been reported in canines. This case report describes the clinical presentation, diagnostic work-up, treatment, and outcome of a canine case confirmed to have hematopoietic tissue within multiple joints. ANIMAL: A client-owned canine. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The clinical presentation was most consistent with immune-mediated polyarthritis, and arthrocentesis was performed in multiple joints for cytological evaluation and culture. Cytology revealed evidence of extramedullary hematopoiesis, and shortly thereafter the dog was diagnosed with immune-mediated hemolytic anemia and thrombocytopenia. TREATMENT AND OUTCOME: Pregabalin, prednisolone, clopidogrel, and cyclosporine were started, and after several recheck appointments and dose adjustments, the dog's clinical signs resolved for all conditions. CLINICAL RELEVANCE: Unusual sites of extramedullary hematopoietic tissue may result in a clinical presentation for which more traditional etiologies and differentials are not applicable.

Use of a novel shockwave trode results in better patient acceptance in awake canine patients treated for musculoskeletal disease.

Introduction: Extracorporeal shockwave therapy (ESWT) is used as a treatment option for several musculoskeletal pathologies in dogs. When performing ESWT using electrohydraulic devices, sedation is commonly recommended due to the noise and discomfort associated with the treatment. The aim of this study was to compare the tolerance of ESWT delivered by a standard or novel trode in awake canine patients with musculoskeletal disease. Materials and methods: This was a prospective, blinded clinical trial in which dogs with musculoskeletal disease received awake treatment with ESWT with a gradually increasing energy protocol using both standard and novel trodes with an electrohydraulic generator in a randomized fashion. Noise reactivity and tolerance to treatment as measured in number of shocks and energy level achieved were recorded. Results: Forty client-owned dogs with pathology affecting the hips, stifles, elbows, or shoulders were enrolled. Thirty-three dogs completed all three treatment sessions, three dogs completed two sessions, and four dogs completed one session. There was evidence of improved patient tolerability with the novel trode, based on an increased average number of shocks delivered (n ± SD = 848 ± 334 for novel trode; n ± SD = 767 ± 358 for standard trode; p = 0.0384) and higher average treatment energy level achieved (E ± SD = 6.5 ± 2.5 for novel trode; E ± SD = 5.3 ± 2.8 for standard trode; p = < 0.001). Decreased noise reactivity was found to be positively correlated with tolerability of shockwave treatment (energy level: p = 0.0168; number of shocks: p = 0.0097). Discussion: Administration of electrohydraulic ESWT is feasible in select awake patients using a gradually increasing energy protocol, and the tested novel shockwave trode is better tolerated than the standard trode. Further studies are required to determine the efficacy of the novel trode, and if gradually increasing energy protocols are clinically equivalent to current standard protocols that employ a consistent energy level.

What to Teach in Small Animal Veterinary Orthopedics: A Survey of Practicing Veterinarians to Inform Curriculum Development.

Competency-based veterinary education focuses on the knowledge and clinical skills required to generate a productive and confident practitioner. Accurate identification of clinically relevant core competencies enables academic institutions to prioritize which new and foundational information to cover in the limited time available. The goal of this study was to aggregate the opinions of veterinary practitioners about small animal core competencies in veterinary orthopedics. An online 20-question survey was distributed with questions regarding respondent demographics, education, practice type, caseload, involvement in orthopedic procedures, access to referral hospitals, frequency of orthopedic condition presentation and procedure performance, and proposed percent allocation of various orthopedic curriculum topics. Responses were included from 721 respondents, largely first-opinion veterinarians (81%, n = 580/721). The majority (58%; n = 418/721) of respondents performed less than 10% of the orthopedic surgeries themselves and, 37% (n = 266/721) reported never performing orthopedic surgery; of those performing surgeries, 78% (n = 354/455) performed less than six orthopedic procedures monthly. The five most common orthopedic conditions seen included: generalized osteoarthritis, patellar luxation, cranial cruciate ligament disease, hip dysplasia/arthritis, and muscle/tendon injuries. Median respondent scores for the percentage which a topic should comprise in an ideal orthopedic curriculum were 20% each for 'orthopedic exam' and for 'non-surgical orthopedic knowledge', 15% each for 'non-surgical orthopedic skills,' 'orthopedic imaging (radiographs),' and 'surgical orthopedic knowledge,' 10% for 'surgical orthopedic skills,' and 2% for 'advanced orthopedic imaging.' Based on these results, a curriculum focusing on the most clinically relevant orthopedic conditions with an emphasis on diagnosis establishment and non-surgical treatments is proposed.

Prospective evaluation of complications associated with orthosis and prosthesis use in canine patients.

Introduction: The use of orthoses and prostheses is expanding in veterinary medicine. However, research evaluating the efficacy and complications of these devices in veterinary patients is limited. The primary objective of this study was to prospectively determine the complications and outcomes associated with custom orthosis and prosthesis use in the canine patient. Materials and Methods: This was a prospective, clinical trial that followed patients for 12 months following device fitting. Owner-perceived complications, clinical metrology instruments, and objective gait analysis were used as outcome measures at various time points. The patients were grouped into the following four major categories: Patients with a carpal orthosis, patients with a stifle orthosis, patients with a tarsal orthosis, and patients with a prosthetic device. Results: Forty-three patients were included in the study. Thirty-nine out of 43 patients (91%) experienced at least one complication, with 7/7 (100%) prosthesis patients experiencing at least one complication. At least one skin complication was reported for the following patient groups during the first 3 months of use: 8/14 (58%) stifle orthoses, 9/10 (90%) carpal orthoses, 6/10 (60%) tarsal orthoses, and 4/7 (58%) prostheses. Patient non-acceptance of the device was identified in 2/15 (14%) stifle orthoses, 1/10 (10%) tarsal orthoses, and 4/7 (55%) prostheses. One out of 15 (7%) stifle orthoses, 4/10 (40%) carpal orthoses, 4/10 (40%) tarsal orthoses, and 1/7 (15%) prostheses experienced mechanical device problems necessitating repair. The majority of patients with carpal and stifle orthoses showed improvement on objective gait analysis in percent body weight distribution of the affected limb between baseline and the most recent follow-up without the device donned: 83% (n = 6) of patients with carpal orthoses, 100% (n = 11) of patients with stifle orthoses. None of the patients with tarsal orthoses showed a similar improvement (0%; n = 4). Discussion and conclusion: Three major complications associated with canine orthosis and prosthesis use were identified in this study as follows: Skin complications (abrasions, loss of hair, and sores), mechanical device problems, and patient non-acceptance of the device. Owners should be notified of these potential complications prior to pursuing orthoses or prostheses as a potential treatment option. Although clinical improvement was noted in the majority of patients with stifle and carpal pathology, given the lack of a control group, it is unknown how much of this improvement can be attributed to the orthoses.

Appendicular skeletal muscle mass assessment in dogs: a scoping literature review.

BACKGROUND: Monitoring changes in appendicular skeletal muscle mass is frequently used as a surrogate marker for limb function. The primary objective of this study was to review scientific information related to the assessment of appendicular skeletal muscle mass in dogs. The secondary objective was to develop practical recommendations for serial evaluation of muscle mass. METHODS: A scoping review was conducted with a systematic search of PubMed, Web of Science, CAB abstract, and Cochrane from inception to June 2021. The following modalities were included in the search: limb circumference, diagnostic ultrasound, computed tomography, magnetic resonance imaging, and dual-energy x-ray absorptiometry. RESULTS: A total of 62 articles that measured appendicular skeletal muscle mass in dogs were identified. Limb circumference (55 articles) was the most commonly used modality. Its reliability was investigated in five studies. Several factors, including measuring tape type, body position, joint angles, and the presence of hair coat, were reported as variables that can affect measurements. Diagnostic ultrasound (five articles) was validated in three articles, but there is scarce information about observer reliability and variables affecting the measurement. Computed tomography (four articles) and magnetic resonance imaging (one article) have been used to validate other modalities at a single time point rather than as a clinical tool for serial muscle mass monitoring. Dual-energy x-ray absorptiometry (two articles) has been used to quantify specific skeletal muscle mass but was mainly used to evaluate body composition in dogs. CONCLUSION: Limb circumference and ultrasound are likely the main modalities that will continue to be used for serial muscle mass measurement in the clinical setting unless a new technology is developed. The reliability of limb circumference is questionable. Several key factors, including measuring tape type, body position, joint angles, and coat clipping, need to be controlled to improve the reliability of limb circumference measurements. Ultrasound may provide a reasonable alternative, but further studies are required to evaluate the reliability of this modality and identify factors that influence ultrasound measurements.

Intra-Articular Injections of Allogeneic Mesenchymal Stromal Cells vs. High Molecular Weight Hyaluronic Acid in Dogs With Osteoarthritis: Exploratory Data From a Double-Blind, Randomized, Prospective Clinical Trial.

This double-blind, randomized, prospective clinical trial was conducted to obtain exploratory data comparing the efficacy of intra-articular allogeneic mesenchymal stem/stromal cells (MSC) to high molecular weight hyaluronic acid (HA) for the treatment of pain associated with canine osteoarthritis (OA). Objective gait analysis (%Body Weight Distribution, %BWD), accelerometry, clinical metrology instruments and veterinary exams were used as outcome measures during various time points throughout the 48-week study period. Fourteen dogs with elbow or coxofemoral OA were enrolled and assigned in a 2:1 ratio to the treatment groups. Each patient received a set of two injections 4 weeks apart. Self-limiting joint flare was observed in seven patients, with six of these in the MSC group. Ten patients completed all follow-up appointments. Both treatment groups showed evidence of mild improvement following the treatment, but the results were inconsistent among the various outcome measures assessed. Overall, dogs enrolled in the HA group showed greater improvement compared to the MSC group. The primary outcome measure, %BWD, showed evidence of improvement, when compared to baseline values, at 36 weeks after injection for the HA group only (p = 0.048, estimated difference: 4.7). Similarly, when treatment groups were compared, evidence of a difference between treatment groups (with the HA-group showing greater improvement) were identified for weeks 24 and 36 (p = 0.02 and 0.01, respectively). The small sample size of this exploratory study does not allow firm conclusions. However, until studies with larger sample sizes are available, the current literature combined with our data do not support the clinical use of intra-articular MSC therapy over high molecular weight HA for the treatment of canine OA at this time.

A pilot study examining a proprietary herbal blend for the treatment of canine osteoarthritis pain.

Osteoarthritis is the most common joint disease in dogs. Despite the use of nonsteroidal anti-inflammatory drugs (NSAIDs), many owners seek natural therapies; either to augment the response to NSAIDs, or as a replacement. Substantial research has been directed to investigation of novel therapies. A randomized, double-blinded, controlled study was conducted to assess the efficacy of a herbal remedy for treatment of canine osteoarthritis pain. Client-owned dogs (N = 24) with osteoarthritis were enrolled between 2 veterinary hospitals. Each dog underwent veterinary and owner assessment at 0, 4, and 8 weeks, using the Canine Brief Pain Inventory and Hudson activity scale. Blood was collected for a complete blood (cell) count (CBC) and serum chemistry analysis. The product was deemed to be safe and well-tolerated at the manufacturer recommended dosage, with no significant changes seen in the CBC or serum biochemical analyses. Aside from1 dog that developed gastrointestinal upset, all other dogs tolerated the supplement without complication. The supplement did not statistically improve clinical signs in dogs based on veterinary or owner assessments of lameness. There was a treatment/time effect when assessing veterinary pain scores; however, post-hoc analysis suggests no observable benefit of treatment compared with the placebo group at any time point.

Une étude pilote examinant un mélange d'herbes exclusif pour le traitement de la douleur arthrosique canine. L'arthrose est la maladie articulaire la plus fréquente chez le chien. Malgré l'utilisation d'antiinflammatoires non stéroïdiens (AINS), de nombreux propriétaires recherchent des thérapies naturelles; soit pour augmenter la réponse aux AINS, soit en remplacement. De nombreuses recherches ont été dirigées vers l'étude de nouvelles thérapies. Une étude randomisée, en double aveugle et contrôlée a été menée pour évaluer l'efficacité d'un remède à base de plantes pour le traitement de la douleur arthrosique canine. Les chiens appartenant à des clients (N = 24) souffrant d'arthrose ont été inscrits auprès de deux hôpitaux vétérinaires. Chaque chien a subi une évaluation vétérinaire et par le propriétaire à 0, 4 et 8 semaines, en utilisant le Canine Brief Pain Inventory et l'échelle d'activité Hudson. Du sang a été prélevé pour une numération sanguine complète (CBC) et une analyse biochimique du sérum. Le produit a été jugé sûr et bien toléré à la dose recommandée par le fabricant, sans aucun changement significatif observé dans le CBC ou les analyses biochimiques sériques. Mis à part un chien qui a développé des troubles gastro-intestinaux; tous les autres chiens ont toléré le supplément sans complication. Le supplément n'a pas amélioré statistiquement les signes cliniques chez les chiens sur la base des évaluations vétérinaires ou du propriétaire de la boiterie. Il y avait un effet traitement/temps lors de l'évaluation des scores de douleur vétérinaire; cependant, l'analyse post-hoc ne suggère aucun avantage observable du traitement par rapport au groupe placebo à aucun moment.(Traduit par Dr Serge Messier).

Evaluation of the efficacy of a cannabidiol and cannabidiolic acid rich hemp extract for pain in dogs following a tibial plateau leveling osteotomy.

Objective: To determine the impact of a cannabidiol (CBD) and cannabidiolic acid (CBDA) rich hemp product on acute post-operative pain in dogs following a tibial plateau leveling osteotomy (TPLO), and to evaluate for changes in early bone healing, serum chemistry profiles, and complete blood counts. Methods: In this randomized, placebo controlled, blinded clinical trial, 44 client-owned dogs were assigned to receive either a CBD/CBDA product dosed at 2-2.5 mg/kg PO every 12 h or a placebo for 4 weeks following a TPLO. Variables evaluated before (week 0), and at 2 and 4 weeks post-operatively included standardized veterinary assessments for pain score, weight-bearing, and lameness, the Canine Brief Pain Inventory (pain interference score-PIS, pain severity score-PSS), and serum biochemistry. Complete blood counts were performed at weeks 0 and 4. Additionally, orthogonal radiographs evaluating the degree of healing were taken at week 4. A mixed model analysis, analyzing changes of variables of interest from enrollment baseline to all other time points was utilized, with a p-value ≤ 0.05 considered significant. Results: Of the 44 enrolled patients, 3 were lost to follow up and excluded from analysis. No significant differences were noted between placebo (n = 19) and CBD/CBDA (n = 22) groups at any point in pain score, degree of lameness, degree of weight-bearing, PIS, PSS, or radiographic healing of the osteotomy. A significant finding of elevation of ALP above normal reference range in the treatment group was identified (p = 0.02) and eosinophil count was affected by treatment (p = 0.01), increasing from baseline in placebo and decreasing in treatment groups. Finally, a significant difference (p = 0.03) was noted at 2 weeks post-operatively where 4 patients in the placebo group and no treatment patients received trazodone to facilitate activity restrictions. Clinical significance: Use of a CBD/CBDA rich hemp product dosed at 2-2.5 mg/kg PO every 12 h did not have a significant impact on pain or delay early bone healing. A statistically significant increase in ALP, decrease in eosinophils, and reduced use of trazodone was identified in the treatment group.

Common Uses and Adverse Effects of Hyperbaric Oxygen Therapy in a Cohort of Small Animal Patients: A Retrospective Analysis of 2,792 Treatment Sessions.

Hyperbaric oxygen therapy (HBOT) is commonly utilized for various human conditions with a low incidence of major adverse effects (0.002-0.035%). Despite growing use in veterinary patients, there remains a paucity of literature describing its use and associated complications. The purpose of this study was to report clinical use of HBOT in small animals and identify the rate of major adverse events at a university teaching hospital. Electronic medical records were searched for small animals receiving HBOT between November 2012 and February 2020. Data extracted from the medical records included signalment, treatment indication, and adverse events. Treatment sessions totaled 2,792 in 542 dogs, 24 cats, and 10 pocket pets and exotics. Common indications included neurologic injuries (50.4%), tissue healing (31.4%), control of oomycete infection (5.5%), neoplasia or post-radiation injury (5.4%), and various miscellaneous conditions (7.4%). Observed minor adverse events included agitation in two dogs and vomiting in three dogs. The most common major adverse event was central nervous system (CNS) oxygen toxicity in 19 dogs. Central nervous system oxygen toxicity, manifesting as focal or generalized seizures, occurred in 0.7% of treatment sessions, with increasing age (p = 0.01) and female sex (p = 0.01) identified as risk factors. One dog developed pulmonary edema following HBOT which is a reported adverse event in humans or may have been a manifestation of progression of the dog's underlying disease. No adverse events were noted in cats or other species. In conclusion, HBOT appeared safe across various indications, although oxygen toxicity affecting the CNS was higher than reports in humans. Future prospective, randomized, controlled trials should evaluate specific clinical indications and outcomes.

Long-term outcome following cranial biceps brachii tendon transposition in a dog with a traumatic cranial scapulohumeral luxation.

Background: Cranial luxation of the scapulohumeral has been rarely reported in dogs and there is limited information available regarding surgical management of this condition, particularly with respect to long-term functional outcomes. Case Description: This report describes the successful resolution of a chronic traumatic cranial scapulohumeral joint luxation in a dog that was stabilized by cranial transposition of the biceps brachii tendon of origin. At surgery, an osteotomy of the greater tubercle was performed and a trough was made in the exposed bed of the osteotomy. The transverse humeral ligament was incised, and the bicipital tendon was levered into the trough and secured in that location by reattachment of the greater tubercle using multiple Kirschner wires and a figure-of-eight tension band wire. Postoperatively, the dog was maintained in a Spica splint for 2 weeks. Although surgical reduction was performed 4 months after the original injury, the luxation did not recur and the dog did not have appreciable lameness 14 months following the surgery. Conclusion: Although cranial transposition of the bicipital tendon is an invasive procedure, this dog's scapulohumeral luxation did not recur and the procedure yielded an excellent long-term functional outcome.

Effects of laser power, wavelength, coat length, and coat color on tissue penetration using photobiomodulation in healthy dogs.

Photobiomodulation is an accepted regenerative medicine treatment modality used to stimulate tissue repair, mediate inflammation, and improve mobility in humans and animals. The objective of this study was to assess the influence of laser power and wavelength, coat length and color, and shaving on in-vivo photon delivery by therapeutic laser in dogs. Forty-seven dogs of various breeds and coat colors (17 black, 15 brown, and 15 white) and with varying coat lengths were assessed with 2 commercially available veterinary lasers. Photons were delivered to the lateral aspect of the inguinal fold and calcaneal tendon, with direct penetration through the dermis, as well as dermis and tendon, as measured with a thermopile laser sensor. Significant impacts on laser transmission were noted for laser power (P = 0.001), wavelength (P < 0.002), coat color (P < 0.001), and shaved coat (P < 0.001). Percent transmission was higher for a class IV 810/980 nm wavelength laser at 0.5 W than for a class IIIb 904 nm laser (P < 0.001). There was a significant difference between transmission of photons among white, brown, and black coats, with less transmission noted with increasing coat pigment (P < 0.001). Transmission was greater at higher power levels (3 W, 5 W) Results showed significant differences in laser transmission for all variables assessed, with the exception of coat length, which was not a significant predictor of laser transmission. As transmission was significantly reduced in darker and unshaved areas, higher power lasers may be necessary for darker pigmented dogs and shaving of hair is recommended before laser therapy.

La photobiomodulation est une modalité de traitement médical régénérateur acceptée utilisée pour stimuler la réparation tissulaire, diminuer l'inflammation et améliorer la mobilité chez les humains et les animaux. L'objectif de la présente étude était d'évaluer l'influence de la puissance et de la longueur d'ondes du laser, la couleur et la longueur du pelage, et le rasage sur la livraison in vivo de photons par un laser thérapeutique chez des chiens. Quarante-sept chiens de races diverses et de couleurs de pelage différentes (17 noirs, 15 bruns et 15 blancs) et avec des longueurs de pelage différentes furent évalués avec deux lasers vétérinaires disponibles commercialement. Les photons étaient délivrés sur l'aspect latéral du repli inguinal et sur le tendon calcanéen, avec pénétration directe à travers le derme, ainsi qu'à travers le derme et le tendon, tel que mesuré avec un capteur laser thermopile. Des impacts significatifs sur la transmission du laser furent notés pour la puissance du laser (P = 0,001), la longueur d'ondes (P < 0,002), la couleur du pelage (P < 0,001) et le rasage du poil (P < 0,001). Le pourcentage de transmission était plus élevé pour un laser de classe IV à longueur d'ondes 810/980 nm à 0,5 W que pour un laser de classe IIIb à longueur d'ondes de 904 nm (P < 0,001). Il y avait une différence significative entre la transmission des photons parmi les pelages blancs, bruns et noirs, avec moins de transmission notée avec une augmentation de la pigmentation du pelage (P < 0,001). La transmission était supérieure à des niveaux de puissance plus élevés (3 W, 5W). Les résultats montrent des différences significatives dans la transmission du laser pour toutes les variables mesurées, à l'exception de la longueur du pelage, qui n'était pas un prédicteur significatif de la transmission du laser. Étant donné que la transmission était réduite significativement dans les endroits plus foncés et non-rasés, des lasers de plus forte puissance pourraient être nécessaires pour des chiens à pigmentation plus foncée et le rasage des poils avant la thérapie au laser est recommandé.(Traduit par Docteur Serge Messier).