Prolonged survival in an aged Labrador retriever with a metastatic insulinoma.

This case report highlights an unusually prolonged, asymptomatic, disease-free interval in an aged male Labrador retriever that underwent partial pancreatectomy for a functionally active pancreatic insulinoma with histologically confirmed hepatic metastasis. The patient developed pancreatitis and nonseptic suppurative peritonitis 24 hr after surgical resection of the insulinoma and was managed medically until discharge. Three mo after surgery, the dog was diagnosed with exocrine pancreatic insufficiency (EPI) that was effectively managed with parenteral pancreatic enzymes. Due to normal glucose levels 3 mo postsurgically, liver samples from the initial surgery were resubmitted for immunohistochemistry. Results confirmed insulinoma metastasis with insulin expression. Ten mo postsurgically, the blood glucose was normal and serum insulin levels were slightly above the upper reference limit. The first hypoglycemic episode was documented 23 mo postoperatively, which was effectively managed with prednisone. The cause for the prolonged disease remission and survival was unknown, but was possibly a result of pancreatitis and peritonitis, partial spontaneous regression of metastatic lesions, or idiopathic. Despite life-threatening postoperative complications, this patient enjoyed a profoundly longer than expected survival. This case highlights the importance of removing the primary tumor (insulinoma) despite the presence of metastatic disease.

Use of Rehabilitation Therapy in Palliative Care Patients.

Palliative care is a unique area of veterinary medicine, where primary goals include maintaining quality of life, as opposed to treating with a curative intent. Using the disablement model and client partnership allows for the development of a function-targeted treatment plan individualized to patient and family needs. Rehabilitation modalities, especially when combined with adaptive pain management, are well-suited to palliative care because they can greatly enhance a patient's ability to achieve improved function and quality of life. These areas join in a concept called palliative rehabilitation which combines the unique needs of these patients and the tools accessible to the rehabilitation practitioner.

Physical Rehabilitation in Zoological Companion Animals.

Animal physical rehabilitation is one of the fast-growing fields in veterinary medicine in recent years. It has become increasingly common in small animal practice and will continue to emerge as an essential aspect of veterinary medicine that plays a vital role in the care of animals with physical impairments or disabilities from surgery, injuries, or diseases.1 This is true now more than ever because of the increasing advances in lifesaving treatments, the increased lifespan of companion animals, and the growth of chronic conditions, of which many are associated with movement disorders. The American Association of Rehabilitation Veterinarians (AARV) defines APR as "the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems." Rehabilitation not only focuses on recovery after surgical procedures but also on improving the function and quality of life in animals suffering from debilitating diseases such as arthritis or neurologic disorders. The overall goal of APR is to decrease pain, reduce edema, promote tissue healing, restore gait and mobility to its prior activity level, regain strength, prevent further injury, and promote optimal quality of life. Typically, a multimodal approach with pharmaceutical and nonpharmaceutical interventions is used by APR therapists to manage patients during their recovery. The purpose of this article aims to provide knowledge and guidance on physical rehabilitation to help veterinarians in the proper return of their patients with ZCA safely after injury and/or surgery.

Nonsurgical Rehabilitation in Dachshunds With T3-L3 Myelopathy: Prognosis and Rates of Recurrence.

Dachshunds are at significant risk of experiencing thoracolumbar intervertebral disk herniation (IVDH) during their lifetimes. Standard of care includes advanced imaging, surgical intervention, and postoperative rehabilitation. Conservative management is commonly recommended for cases where the standard of care is declined, and little is known about the prognosis of treatment with conservative management and rehabilitation (nonsurgical rehabilitation). This retrospective cohort study assessed 12-week functional outcome and recurrence of clinical signs in 40 dachshunds with T3-L3 myelopathy presumed to be due to Hansen's Type I disc herniation, treated with nonsurgical rehabilitation. The overall prognosis was good with 34 of 40 (85.0%, 95% CI 70.2-94.2) dachshunds achieving functional pet status by 12 weeks postinjury. Modified Frankel Score at presentation was significantly (p < 0.001) higher in dogs with a positive 12-week outcome compared to dogs that did not recover by 12 weeks. All 27 dogs with motor function at presentation had a positive outcome. Of the 9 dogs exhibiting paraplegia with intact deep nociception at presentation, 7 dogs (77.8%) had achieved a positive outcome by 12 weeks. None of the 4 dogs persistently lacking deep nociception had a positive outcome. Among 27 dogs with a positive outcome for whom follow-up records were available, the 1- and 2-year recurrence rates for T3-L3 myelopathy were 5 and 11%, respectively. Nonsurgical rehabilitation should be considered in dachshunds with mild to moderate T3-L3 myelopathy or in severe cases when advanced imaging and surgical intervention are not possible.

Internet Survey Evaluation of Iliopsoas Injury in Dogs Participating in Agility Competitions.

Objective: To describe risk factors associated with demographics, training, and competition for iliopsoas injury in dogs participating in agility competitions, as well as describe owner reported treatment and return to sport following injury. Procedures: An internet-based survey of agility handlers collected risk factor data for dogs participating in agility. Owners were asked questions about demographics, training, and competition as well as injury treatment and recovery if applicable. Associations between variables of interest and iliopsoas injury were estimated with logistic regression. The final risk factor model was built via modified backward selection, with all variables in the final model showing significant associations at p < 0.05. Results: Of the 4,197 dogs in the sample, 327 (7.8%) reported iliopsoas injury. The final model identified six risk factors for iliopsoas injury. A higher risk of iliopsoas injury was observed for the Border Collie breed, dogs with handlers who are veterinary assistants, dogs competing on dirt, dogs competing on artificial turf 6+ times a year, and dogs that trained with the 2 × 2 method for weave poles. Dogs that were not acquired with agility in mind were observed to have a decreased risk of injury. Factors like number of competition days and jump height were not significantly associated with risk of iliopsoas injury. Owners sought veterinary care for 88% of dogs with iliopsoas injury, including specialty care for 63%. Treatment most often included rest, home rehabilitation, formal rehabilitation, and/or oral medications. Most dogs (80%) were able to return to sport within 6 months, while 20% were out for longer than 6 months, or retired. Conclusion and Clinical Relevance: Iliopsoas injury can necessitate a significant amount of time off from training and competition, and even lead to retirement of dogs competing in agility. Some of the risk factors identified in this study can inherently not be modified (breed, intended use, and handler profession), but can be taken into consideration for injury prevention strategies. Competition and training risk factors that can be modified, such as weave training, may help to inform guidelines for best practices in management of the agility athlete.

Comparison of the efficacy and adverse effects of sustained-release buprenorphine hydrochloride following subcutaneous administration and buprenorphine hydrochloride following oral transmucosal administration in cats undergoing ovariohysterectomy.

OBJECTIVE: To compare the efficacy and adverse effects of sustained-release (SR) buprenorphine following SC administration and buprenorphine following oral transmucosal (OTM) administration in cats undergoing ovariohysterectomy. Animals-21 young healthy female cats. PROCEDURES: As part of anesthetic premedication (0 hours), 10 cats received buprenorphine (0.02 mg/kg) via OTM administration with additional doses at 12, 24, 36, 48, and 60 hours and 11 cats received an equivalent total dose as a single SC injection of SR buprenorphine (0.12 mg/kg). The SR product contained buprenorphine hydrochloride in a proprietary SR matrix. All other anesthetic drugs and a single postoperative dose of meloxicam were administered similarly to all cats. Behavioral and physiologic variables were recorded, and signs of pain were assessed by use of 2 pain assessment scales and von Frey filament testing in each cat prior to premedication administration (baseline), during recovery from anesthesia (RFA), and at 12, 24, 36, 48, 60, and 72 hours. RESULTS: Heart rate increased and temperature (determined via microchip transponder thermometry) decreased from baseline values during RFA in both groups. Compared with baseline values, pain scores were increased during RFA and at the 12- and 24-hour time points in both groups; von Frey scores were higher during RFA. Behavioral and physiologic variables did not differ significantly between groups at any time point. CONCLUSIONS AND CLINICAL RELEVANCE: In cats undergoing ovariohysterectomy, SC administration of a preoperative dose of SR buprenorphine appeared to have comparable efficacy and adverse effect profile as that of twice-daily OTM administration of buprenorphine before and after surgery.

Acupuncture for analgesia in veterinary medicine.

Acupuncture for analgesia is growing rapidly in popularity with veterinarians and pet owners. This article summarizes the mechanisms of analgesia derived from acupuncture and reviews current literature on the topic. Areas covered include the local effects at area of needle insertion, systemic effects secondary to circulating neurotransmitters and changes in cell signaling, central nervous system effects including the brain and spinal cord, and myofascial trigger point and pathology treatment. Clinical applications are discussed and suggested in each section. When used by appropriately trained professionals, acupuncture offers a compelling and safe method for pain management in our veterinary patients and should be strongly considered as a part of multimodal pain management plans.

Zoologic companion animal rehabilitation and physical medicine.

Injury and illness in zoologic companion animals can lead to significant pain and debilitation. Recovery can be slow and sometimes frustrating. By augmenting recovery from trauma or disease with physical medicine and rehabilitation techniques, recovery can be more rapid and complete. Physical medicine techniques, such as massage, can augment recovery from a painful injury or surgery by reducing edema, improving postoperative ileus, and decreasing anxiety. Familiarity with the tools of rehabilitation along with focus on pain management, strengthening, and proprioception improve patient care.

Diagnosis and treatment of osteoarthritis.

Osteoarthritis (OA) is a common disease in aging dogs and cats but frequently goes undiagnosed and untreated. Although OA cannot be cured, long-term management of the disease can be very rewarding for the veterinary medical team as well as pet owners. Managing pain with pain medications is an essential first step. There are a wealth of pain medications available, including nonsteroidal antiinflammatory drugs, gabapentin, amantadine, and tramadol. There are also physical modalities available for pain reduction. Weight management and nutritional joint support are also important in aspects of managing OA in dogs and cats. Finally, physical rehabilitation is a great way to improve mobility and keep pets active as they age.