ABSTRACT
Musculoskeletal disease is a common cause of chronic pain that is often overlooked and inadequately treated, impacting the quality of life of humans and horses alike. Lameness due to musculoskeletal pain is prevalent in horses, but the perception of pain by owners is low compared with veterinary diagnosis. Therefore, this study aims to establish and validate a pain scale for chronic equine orthopaedic pain that is user-friendly for horse owners and veterinarians to facilitate the identification and monitoring of pain in horses. The newly developed musculoskeletal pain scale (MPS) was applied to 154 horses (mean age 20 ± 6.4 years SD) housed at an equine sanctuary, of which 128 (83%) suffered from chronic orthopaedic disease. To complete the MPS, the horses were observed and videotaped from a distance while at rest in their box or enclosure. In addition, they received a complete clinical and orthopaedic exam. The need for veterinary intervention to address pain (assessed and executed by the sanctuary independent from this study) was used as a longitudinal health outcome to determine the MPS's predictive validity. To determine the interrater agreement, the MPS was scored for a randomly selected subset of 30 horses by six additional blinded raters, three equine veterinary practitioners, and three experienced equestrians. An iterative process was used to refine the tool based on improvements in the MPS's correlation with lameness evaluated at the walk and trot, predictive validity for longitudinal health outcomes, and interrater agreement. The intraclass correlation improved from 0.77 of the original MPS to 0.88 of the refined version (95% confidence interval: 0.8-0.94). The refined MPS correlated significantly with lameness at the walk (r = 0.44, p = 0.001) and trot (r = 0.5, p < 0.0001). The refined MPS significantly differed between horses that needed veterinary intervention (mean MPS = 8.6) and those that did not (mean MPS = 5.0, p = 0.0007). In summary, the MPS showed good interrater repeatability between expert and lay scorers, significant correlation with lameness at the walk and trot, and good predictive validity for longitudinal health outcomes, confirming its ability to identify horses with orthopaedic health problems.
ABSTRACT
A 3.5-y-old Whippet mixed-breed dog was presented with a history of respiratory distress, exercise intolerance, and generalized demodicosis. Hematologic alterations included marked leukocytosis and neutrophilia. Radiographic examination showed a diffuse interstitial and mild peripheral alveolar lung pattern and pneumomediastinum. Because the cytologic examination of the bronchoalveolar aspirate was not diagnostic and a persistent perforation of the upper respiratory tract could not be ruled out, the dog was submitted to thoracoscopy, and subsequently the left cranial lung lobe as well as mediastinal and sternal lymph nodes were resected. Pulmonary pneumocystosis with spread to the thoracic lymph nodes was suspected after histologic investigation of lung and lymph nodes, which was confirmed by in situ hybridization, PCR, and subsequent Sanger sequencing. We document a rare, simultaneous occurrence of severe pulmonary and thoracic lymph node pneumocystosis with spontaneous pneumomediastinum in a dog. Definitive diagnosis was achieved through the use of Grocott methenamine silver staining, in situ hybridization, and PCR.