Endoscopy Training in Small Animal Internal Medicine: A Survey of Residency Training Programs in North America.

Competency in multiple endoscopic techniques is a major goal of small animal internal medicine (SAIM) residency programs. Training relies predominantly on mentored supervision of procedures performed on patients. Supplementation of this apprenticeship model with classroom sessions and hands-on laboratories can be advantageous to trainees and patients. Few veterinary resources describe supplemental training options, and no single source exists for mentors to consult for program development. The purpose of this study was to describe the supplemental training opportunities currently available to SAIM residents at academic hospitals in the US and Canada and to compare their timing during the residency, resident and faculty time commitment, and perceived helpfulness. Data were collected by an electronic survey distributed to one faculty member per institution. The response rate was 80% (24/30). Most programs (22/24; 92%) offered some form of supplemental training, including classroom sessions (9/24) and hands-on laboratories using physical models (7/24), virtual reality simulators (2/24), and cadaver (2/24) and anesthetized (2/24) dogs. Fifteen programs provided residents with the opportunity to attend external endoscopy workshops. Only three programs required any training prior to residents performing procedures on patients. There was considerable variability in training between programs, precluding statistical comparisons. The survey identified topics for classroom sessions and several inexpensive physical models, rated very or extremely helpful, that would be suitable for programs with limited budgets. A human-based virtual reality simulator was also rated highly by two programs. Comprehensive, external workshops evoked numerous positive comments with perceived value ranging from somewhat to extremely helpful.

Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors. Effects on resident training are program specific, with duty hours restrictions having the most deleterious effects on surgical disciplines. Because veterinary specialists assume a similar role in providing 24-hour patient care, interns and residents face work-related stress as a result of extended working hours, on-call duty, and an increasingly complex caseload. The North Carolina State Veterinary Hospital is staffed by approximately 100 house officers representing almost every veterinary specialty group. We surveyed departing house officers regarding their quality of life and training experience. Sixty-six percent of interns and residents reported that they do not have time to take care of personal needs, and 57%-62% felt neutral or dissatisfied with their mental and physical well-being. Most trainees believed that decreased duty hours would improve learning, but 42% believed that decreased caseload would be detrimental to training. Veterinary educators must consider post-DVM veterinary training guidelines that maintain patient care with a good learning environment for interns and residents.

Error reporting in a large animal veterinary teaching hospital identifies medication errors occur most often in the prescribing phase of therapy.

OBJECTIVE: To identify the rate at which medication errors occurred over a 2-year period in a large animal veterinary teaching hospital and describe the types of errors that occurred. SAMPLE: 226 medication errors over 6,155 large animal visits occurred during the study period. Multiple errors may have affected the same patient. METHODS: Medication error reports from March 1, 2021, to March 31, 2023, were reviewed retrospectively and classified by species, type of drug, and month and day of the week the error occurred. Errors were categorized according to multiple previously developed systems to allow for comparison to other studies. RESULTS: 226 medication errors occurred over 6,155 patient visits in a 2-year period: 57.5% (130/226) were identified by a dedicated large animal pharmacist, and 64.2% (145/226) of errors were identified and corrected before reaching the patient. Prescription/medication order errors (58.4% [132/226]) occurred significantly more often than errors in medication preparation (21.7% [49/226]; P < .001) and administration (19.6%; P < .001). Antibiotics (48.7% [110/226]) and NSAIDs (17.7% [40/226]) were the drug classes most involved in errors. CLINICAL RELEVANCE: Most medication errors in this study occurred in the ordering/prescribing phase. This is similar to reports in human medicine, where standardized medication error reporting strategies exist. Developing and applying similar strategies in veterinary medicine may improve patient safety and outcome.

Survey indicates addressing workplace environment, work-life balance, and flexibility are key to attracting and retaining veterinarians in academia.

OBJECTIVE: Referencing growing concerns over the recruitment and retention of faculty in academic veterinary medicine, the authors hypothesized that among surveyed veterinary residents and early-career faculty, work-life balance and workplace climate and culture are stronger motivators than financial considerations, regardless of demographic factors such as gender, race/ethnicity, and area of specialization. SAMPLE: 541 participants were included in data analysis. METHODS: A mixed methods approach was utilized, incorporating both quantitative data and qualitative, free-text responses to better understand veterinary career choices by contextualizing factors associated with academic medicine. RESULTS: Factors underpinning career-related decision-making were ranked by level of importance as (1) workplace environment/culture, (2) personal well-being/work-life balance, (3) salary and bonuses, (4) geographic location, (5) facilities and resources, (6) benefits, and (7) schedule flexibility. Desires for workload balance, schedule flexibility, support from leadership, and mentorship and collaboration were among the top themes of qualitative responses for both residents and early career faculty respondents. Factors influencing career decision-making for resident and early-career faculty are varied. Workplace environment, work-life balance, and schedule flexibility are areas that academic institutions can address and continue to improve and that are likely to positively impact entry into academia and the desire to stay. CLINICAL RELEVANCE: This study sought to understand factors related to career decision-making and interest in academic veterinary medicine among residents and early-career faculty. Understanding these factors can support efforts to recruit and retain faculty in academic veterinary medicine.

Effect of a combined aspiration and core biopsy technique on quality of core bone marrow specimens.

For cases requiring both a bone marrow aspirate and core biopsy, using the same needle and site (i.e., a combined technique) can decrease time, expense, and discomfort compared with the independent (direct) collection of each specimen. The benefits of the combined approach should not be achieved at the expense of specimen quality. In this study, core bone marrow samples obtained from the proximal humerus of 26 dogs by a combined technique immediately posteuthanasia were compared with core samples obtained directly from the opposite humerus. Both core samples from each dog were compared for relative overall quality. Biopsies were unsuccessful in four dogs using the combined technique and in one dog by the direct technique. Marrow length was shorter and hemorrhage artifact was more common using the combined technique. There were no differences in cellularity, megakaryocyte count, the myeloid/erythroid ratio (M/E ratio), iron stores, or diagnostic quality. Direct core biopsy remains the ideal technique; however, the degree of compromise was small in the samples obtained from the combined technique. For clinical patients, the advantages of the combined technique must continue to be weighed against potential loss of diagnostic sensitivity.

Discharge summaries provided to owners of pets newly diagnosed with cancer exceed recommended readability levels.

OBJECTIVE: To analyze the readability of discharge summaries distributed to owners of pets newly diagnosed with cancer. SAMPLE: 118 discharge summaries provided to pet owners following initial consultation. PROCEDURES: A database search identified records of new patients that had been presented to the North Carolina State Veterinary Hospital medical oncology service between June 2017 and January 2019. Owner-directed portions of the summaries provided at the time of discharge were copied and pasted into a document and stripped of all identifying information. Readability of summaries was assessed with the use of 2 previously established readability calculators: the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests. RESULTS: Mean ± SD FKGL was 11.9 ± 1.1 (median, 11.9; range, 8.6 to 15.5; target ≤ 6), and the mean ± SD FRE score was 43 ± 5.9 (median, 42.7; range, 25.5 to 58.1; target ≥ 60). There were no significant differences in FKGL or FRE scores among discharge summaries for patients with the 4 most common tumor types diagnosed or the described treatment options. Ninety-three percent (110/118) of summaries were scored as difficult or very difficult to read. CLINICAL RELEVANCE: Owner-directed written information regarding a diagnosis of cancer at a single teaching hospital exceeded readability levels recommended by the American Medical Association and NIH and was above the average reading level of most US adults. Efforts to improve readability are an important component of promoting relationship-centered care and may improve owner compliance and patient outcomes.

Googling for a veterinary diagnosis: A replication study using Google as a diagnostic aid.

BACKGROUND: The purpose of this study was to replicate in the veterinary context a BMJ study using Google to assist in diagnosis of complex cases. HYPOTHESIS/OBJECTIVES: To assess percentage of diagnoses identified using Google as a diagnostic aid in veterinary medicine. ANIMALS: None; 13 cases in cats and 17 in dogs published in JAVMA. METHODS: Cross-sectional survey of Google results from searches using keywords generated independently by a generalist and a specialist veterinarian who reviewed the published case history and diagnostic components while blind to the diagnosis. They offered diagnoses and generated up to 5 search strategies for each case. The top 30 Google results for each search were reviewed by the generalist to inform a final Google-aided diagnosis. Both veterinarians' initial diagnoses and the Google-aided diagnoses were compared with the published diagnoses. RESULTS: Google searching led to 52 diagnoses out of 60 possible. Twenty-two (42%, 95% confidence interval [95% CI] 29%-55%) Google-aided diagnoses matched the JAVMA diagnosis. This accuracy rate does not differ significantly from 58% (n = 15/26, 95% CI 38%-77%) identified in the BMJ study. Google-aided results were not statistically different from those achieved unaided by each veterinarian (33%, 95% CI 16%-50%). CONCLUSIONS AND CLINICAL IMPORTANCE: Published information found searching Google using keywords related to complicated or unusual cases could assist veterinarians to reinforce their initial diagnosis or consider other differential diagnoses. Search strategies using words representing either signs or the preliminary diagnoses can yield results useful to confirming a correct diagnosis.

Can veterinary medicine improve diversity in post-graduate training programs? Current state of academic veterinary medicine and recommendations on best practices.

The American Association of Veterinary Clinicians (AAVC) convened a Diversity, Equity, and Inclusivity working group in March 2021 to address the limited diversity (including but not limited to ethnic, racial, and cultural diversity) in clinical post-DVM graduate training programs and academic faculty. Concurrent with a working group formation, the AAVC developed a strategic plan. The central mission of the AAVC is to develop, support, and connect academic leaders to fuel the future of the veterinary medical profession. House officers and their training programs are central to all goals outlined in the strategic plan. Amongst other strategic goals, the working group identified best practices for intern and resident recruitment and selection. We report herein from the current health profession literature ways to identify and recruit talented, diverse candidates especially those with non-traditional (atypical) preparation and experience. We also provide recommendations on best practices for intern and resident selection. This document highlights holistic approaches, some of which are incrementally being incorporated into the Veterinary Intern Resident Matching Program application, that emphasize diversity as a selection criteria for intern and resident selection an important step towards building a more resilient and inclusive workforce. These include expanding candidate assessment beyond grades and class rank into a more standardized method for screening candidates that includes consideration of life experiences and talents outside of veterinary medicine.

Veterinary house officer perceptions of dimensions of well-being during postgraduate training.

OBJECTIVE: To describe veterinary house officers' perceptions of dimensions of well-being during postgraduate training and to identify potential areas for targeted intervention. SAMPLE: 303 house officers. PROCEDURES: A 62-item questionnaire was generated by use of an online platform and sent to house officers at participating institutions in October 2020. Responses were analyzed for trends and associations between selected variables. RESULTS: 239 residents, 45 rotating interns, and 19 specialty interns responded to the survey. The majority of house officers felt that their training program negatively interfered with their exercise habits, diet, and social engagement. House officers reported engaging in exercise significantly less during times of clinical responsibility, averaging 1.6 exercise sessions/wk (SD ± 0.8) on clinical duty and 2.4 exercise sessions/wk (SD ± 0.9) when not on clinical duty (P < 0.001). Ninety-four percent of respondents reported experiencing some degree of anxiety regarding their physical health, and 95% of house officers reported feeling some degree of anxiety regarding their current financial situation. Overall, 47% reported that their work-life balance was unsustainable for > 1 year; there was no association between specialty and sustainability of work-life balance. Most house officers were satisfied with their current training program, level of clinical responsibility, and mentorship. CLINICAL RELEVANCE: Veterinary house officers demonstrated a poor balance between the demands of postgraduate training and maintenance of personal health. Thoughtful interventions are needed to support the well-being of veterinary house officers.

Treatment of three cats with hyperviscosity syndrome and congestive heart failure using plasmapheresis.

Three cats were evaluated at a veterinary teaching hospital for congestive heart failure (CHF) secondary to hyperviscosity syndrome from plasma cell neoplasia. All cats had severe hyperproteinemia due to hyperglobulinemia. Multiple myeloma or plasma cell neoplasia was diagnosed based on cytopathology and post mortem examination. The cats presented with signs of CHF including acute collapse, tachypnea, increased respiratory effort, and pulmonary crackles. All cats had heart murmurs and echocardiographic signs consistent with hypertrophic cardiomyopathy. An enlarged left atrium was found in all cats and two of three cats also had spontaneous echocardiographic contrast. Plasmapheresis (centrifugal plasma exchange) was performed on all three cats by the removal of whole blood and the infusion of a balanced electrolyte solution while the whole blood was centrifuged and separated. The RBCs were then washed before being readministered to the patient. Plasmapheresis alleviated the clinical signs of CHF (tachypnea) in all three cats. Plasmapheresis should be considered in cases of CHF secondary to hyperviscosity syndrome to rapidly alleviate clinical signs associated with heart failure while diagnosis of the underlying cause is made and appropriate therapy implemented.

Assessment of Safety Culture at a Veterinary Teaching Hospital in the United States.

This study assessed the fidelity of an existing questionnaire regarding attitudes toward safety culture in an academic veterinary hospital setting and gathered baseline data on these attitudes in a local population. A cross-sectional study design was used to evaluate perceptions held by veterinary teaching hospital employees. An established veterinary safety culture survey was modified and administered as a confidential online survey to faculty, house officers, and professional staff of a veterinary teaching hospital in the United States. Confirmatory and exploratory factor analysis were conducted to compare the adapted survey to the established version. Descriptive statistics were used to characterize baseline safety culture. The adapted survey exhibited factor groupings that were mostly in agreement with, but slightly different from, the original instrument. In general, survey respondents outlined positive attitudes toward the various domains of safety culture, though we identified opportunities for improvement in some areas. An adapted veterinary safety culture survey can be applied to a veterinary teaching hospital in the United States to assess baseline data surrounding the culture of safety and to identify opportunities for focused improvement efforts.

Thrombi in the trachea of a dog secondary to placement of a tracheotomy tube.

CASE DESCRIPTION: A 7-year-old Spaniel-crossbreed dog was evaluated for stertorous breathing and inspiratory stridor. CLINICAL FINDINGS: A temporary tracheotomy tube was placed prior to referral. Results of physical examination at our facility, including thoracic auscultation, were unremarkable. Examination of the larynx revealed a 2 x 2-cm nodular mass on the lateral aspect of the epiglottis and left arytenoid cartilage. Cytologic examination of the mass indicated septic suppurative inflammation and intracellular rod-shaped bacteria. During the procedures, decreased air movement through the temporary tracheotomy tube was detected, and the tube was replaced. A thrombus was found on the distal end of the temporary tracheotomy tube; the thrombus obstructed 90% of the tube lumen. Approximately 12 hours later, auscultation revealed decreased sounds in all lung fields. Cervical and thoracic radiography revealed an intraluminal soft tissue opacity distal to the tracheotomy tube. A thrombus that contained hair and plant material was removed from the trachea by use of an embolectomy catheter and videogastroscope. Approximately 30 hours after removal of the initial thrombus, the dog had an episode of respiratory distress. Cervical radiography revealed another intraluminal opacity. It was another thrombus, which also was removed by use of the videogastroscope. TREATMENT AND OUTCOME: Tracheoscopy was performed with a videogastroscope in an attempt to remove the thrombi. A Fogarty catheter was used to remove the initial intraluminal thrombus from the trachea. CLINICAL RELEVANCE: Airway obstruction resulting from an intraluminal thrombus in the trachea should be considered as a secondary complication after tracheotomy tube placement.

Intrathecal morphine overdose in a dog.

CASE DESCRIPTION: A healthy 6-year-old 28.5-kg (62.7-lb) spayed female Boxer undergoing surgical repair of a ruptured cranial cruciate ligament was inadvertently administered an overdose of morphine (1.3 mg/kg [0.59 mg/lb]) via subarachnoid injection. CLINICAL FINDINGS: 50 minutes after administration of the overdose, mild multifocal myoclonic contractions became apparent at the level of the tail; the contractions migrated cranially and progressively increased in intensity and frequency during completion of the surgery. TREATMENT AND OUTCOME: The myoclonic contractions were refractory to treatment with midazolam, naloxone, phenobarbital, and pentobarbital; only atracurium (0.1 mg/kg [0.045 mg/lb], IV) was effective in controlling the movements. The dog developed hypertension, dysphoria, hyperthermia, and hypercapnia. The dog remained anesthetized and ventilated mechanically; treatments included continuous rate IV infusions of propofol (1 mg/kg/h [0.45 mg/lb/h]), diazepam (0.25 mg/kg/h [0.11 mg/lb/h]), atracurium (0.1 to 0.3 mg/kg/h [0.045 to 0.14 mg/lb/h]), and naloxone (0.02 mg/kg/h [0.009 mg/lb/h]). Twenty-two hours after the overdose, the myoclonus was no longer present, and the dog was able to ventilate without mechanical assistance. The dog remained sedated until 60 hours after the overdose, at which time its mentation improved, including recognition of caregivers and response to voice commands. No neurologic abnormalities were detectable at discharge (approx 68 hours after the overdose) or at a recheck evaluation 1 week later. CLINICAL RELEVANCE: Although intrathecal administration of an overdose of morphine can be associated with major and potentially fatal complications, it is possible that affected dogs can completely recover with immediate treatment and extensive supportive care.

Thromboelastographic monitoring of the effect of unfractionated heparin in healthy dogs.

OBJECTIVE: To characterize the correlation between thromboelastography (TEG) variables using strong activators and anti-Xa (AXa) activity in healthy dogs administered subcutaneous unfractionated heparin (UFH). DESIGN: Prospective experimental study. SETTING: University research facility. ANIMALS: Eight adult random-source male dogs. INTERVENTION: Dogs were randomized to receive subcutaneous UFH at 200, 250, or 300 IU/kg every 8 hours for a total of 10 injections. Blood samples were collected at time 0 (preheparin) and 3, 6, and 8 hours after the 1st (Day 1) and 10th (Day 4) UFH injection.  After the 8-hour blood sample was obtained on day 4, a 100 IU/kg IV bolus of UFH was administered and an additional blood sample was collected 1 hour later (hour 9). AXa activity, activated partial thromboplastin time (aPTT), and TEG (with up to 5 activators) were performed at each time point.  Modes of activation for TEG included  recalcified (Ca), Ca with heparinase (CaH), CaH and tissue factor 1:3600 (CTF3600H), Ca with tissue factor 1:100 (CTF100), and RapidTEG. Spearman rank correlations were calculated for each of the aforementioned parameters and the AXa activity. P-values were corrected for multiple comparisons with a Bonferroni correction. MEASUREMENTS AND MAIN RESULTS: Significant correlations were found between AXa activity and the TEG R values generated with CTF100 (R = 0.83, P ≤ 0.0001) and RapidTEG (R = 0.90, P < 0.0001), as well as both forms of aPTT measurement (R = 0.86 and 0.84, P < 0.0001). CONCLUSIONS: This study demonstrates that TEG variables derived using robust activation correlate with AXa activity as well as aPTT and have the potential to be used for monitoring UFH therapy in healthy dogs.  Future studies are warranted to evaluate its diagnostic utility in critically ill animals.

Dietary-related skeletal changes in a Shetland sheepdog puppy.

A commercially available, renal failure diet was used to manage suspected renal failure in a 10-week-old Shetland sheepdog puppy. Rickets subsequently developed, possibly from low phosphorous intake and an increased calcium to phosphorus ratio. Decreased dietary calcium in addition to decreased phosphorus may have played a role in decreasing bone mineral density. Lethargy, decreased long bone growth, angular limb deformity, and osteopenia occurred, but these signs resolved within 3 months with nutritional management.

AAHA senior care guidelines for dogs and cats.

This paper provides a working framework for enhancing the well-being of senior pet dogs and cats. Approaches to screening the medical status of senior pets are described in detail, with particular emphasis on establishing baseline data in healthy animals, the testing of clinically ill animals, and assessing senior pets prior to anesthesia and surgery. The management of pain and distress and the application of hospice and palliative care are addressed. Advice on ways to approach euthanasia and dealing with end-of-life issues is also provided.

Feasibility of flotation concentration of fungal spores as a method to identify toxigenic mushrooms.

PURPOSE: Mushroom poisoning is a recurring and challenging problem in veterinary medicine. Diagnosis of mushroom exposure in animals is hampered by the lack of rapid diagnostic tests. Our study evaluated the feasibility of using flotation concentration and microscopic evaluation of spores for mushroom identification. Evaluation of this method in living animals exposed to toxigenic mushrooms is limited by ethical constraints; therefore, we relied upon the use of an in vitro model that mimics the oral and gastric phases of digestion. METHODS: In our study, mycologist-identified toxigenic (poisonous) and nontoxigenic fresh mushrooms were collected in North Carolina, USA. In phase 1, quantitative spore recovery rates were determined following magnesium sulfate, modified Sheather's sugar solution, and zinc sulfate flotation (n=16 fungal species). In phase 2, mushrooms (n=40 fungal species) were macerated and digested for up to 2 hours in a salivary and gastric juice simulant. The partially digested material was acid neutralized, filtered, and spores concentrated using zinc sulfate flotation followed by microscopic evaluation of spore morphology. RESULTS: Mean spore recovery rates for the three flotation fluids ranged from 32.5% to 41.0% (P=0.82). Mean (± standard error of the mean) Amanita spp. spore recovery rates were 38.1%±3.4%, 36.9%±8.6%, and 74.5%±1.6% (P=0.0012) for the magnesium sulfate, Sheather's sugar, and zinc sulfate solutions, respectively. Zinc sulfate flotation following in vitro acid digestion (phase 2) yielded spore numbers adequate for microscopic visualization in 97.5% of trials. The most common spore shapes observed were globose, spiked, elliptical, smooth and reticulate. CONCLUSION: Flotation can concentrate mushroom spores; however, false negative results can occur. Spore morphology could not be used to differentiate species of mushroom-forming fungi since the spore shape and surface characteristics seen in the present study were often observed with multiple species of mushroom-forming fungi.

Presumptive intraperitoneal envenomation resulting in hemoperitoneum and acute abdominal pain in a dog.

OBJECTIVE: To describe the clinical features, diagnostic findings, treatment, and outcome of a dog with acute abdominal pain and hemoperitoneum secondary to a presumptive intraperitoneal (IP) snakebite. CASE SUMMARY: A 10-month-old castrated male mixed-breed dog was evaluated for suspected snake envenomation. The dog presented recumbent and tachycardic with signs of severe abdominal pain. Two cutaneous puncture wounds and hemoperitoneum were discovered during evaluation. Ultrasonographic examination revealed communication of the wounds with the peritoneal cavity. The dog was treated with supportive care, parenteral analgesia, packed red blood cell and fresh frozen plasma transfusions, crotalid antivenom, and placement of an IP catheter to provide local analgesia. The dog recovered fully and was discharged 5 days after initial presentation. NEW OR UNIQUE INFORMATION PROVIDED: To our knowledge, this is the first report of IP envenomation accompanied by hemorrhage treated with continuous IP analgesia in the veterinary literature.

Investigation of pulmonary deposition of a nebulized radiopharmaceutical agent in awake cats.

OBJECTIVE: To determine whether conscious, unsedated cats will inhale a nebulized material administered via a facemask and whether this material will reach the lower airways. ANIMALS: 20 healthy adult cats. PROCEDURE: Technetium Tc 99m-diaminetriaminopentaacetic acid (99mTc-DTPA) was nebulized into a spacer and administered to the cats via a closely fitting facemask. By use of a gamma camera, images were then immediately obtained to determine the distribution of 99mTc-DTPA within the lower airways. RESULTS: Images obtained by use of the gamma camera revealed that all 20 cats had inhaled 99mTc-DTPA from the facemask. In each cat, deposition of the radiopharmaceutical agent was evident throughout the lung fields. CONCLUSIONS AND CLINICAL RELEVANCE: Awake cats that were not used to the application of a facemask did inhale substances from such a device. Aerosolization of medications may be a feasible route of administration for cats with lower airway disease.

Neurologic complications after melarsomine dihydrochloride treatment for Dirofilaria immitis in three dogs.

Melarsomine dihydrochloride is highly effective against both sexes of adult and L5 Dirofilaria immitis. Common adverse reactions include injection site irritation and reluctance to move. Neurologic complications associated with i.m. injection of melarsomine dihydrochloride for treatment of heartworm disease in 3 dogs are described. Different degrees of neurologic complications have been identified; the pathophysiologic features are unknown. It is speculated that the compound migrates out of the injection site via fascial planes and causes an ascending inflammation along nerve roots. The resulting extradural cord compression secondary to extensive inflammation and necrosis of epidural fat could induce a variety of neurologic deficits. Alternatively, inappropriate injection technique may result in direct contact of melarsomine with neural tissue. A heightened awareness of proper injection technique might prevent the development of most neurologic complications.