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.

2022 AAHA Pain Management Guidelines for Dogs and Cats.

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

2021 AAFP Feline Senior Care Guidelines.

The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.

Acupuncture for the Treatment of Animal Pain.

Acupuncture is recognized to induce multifactorial changes in the neuroregulatory aspects of pain physiology. Many aspects overlap with known receptor interactions of commonly used analgesic drugs, and acupuncture can increase the efficacy or replace the use of these pharmacologic pain treatments. This article discusses the currently recognized components of the pain pathways that are modified by acupuncture. It introduces the role of fibroblasts and fascia in mechanotransduction and discusses the ways in which this provides a link between the acupuncture needle and the nervous system and is a conduit for extracellular fluid movement, lymphatics, and the immune system.

Determinants of Physician, Sonographer, and Laboratory Productivity: Analysis of the Third Survey from the American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity.

BACKGROUND: The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity was formed in 2011 to study institutional factors that could influence the clinical productivity of physicians and sonographers in academic pediatric echocardiography laboratories. In the previous two surveys, staff clinical productivity remained stable while total echocardiography volumes increased. This third survey was designed to assess how clinical productivity is associated with laboratory infrastructure elements such as training, administrative tasks, quality improvement, research, and use of focused cardiac ultrasound (FCU). METHODS: Survey questions were sent by e-mail to North American laboratories. The aims were to assess (1) educational and training obligations, (2) academic productivity and research, (3) laboratory medical director satisfaction, (4) quality improvement, (5) laboratory leadership roles, and (6) impact and use of FCU. Survey responses were compared with clinical productivity metrics defined in the first two surveys. RESULTS: There were 38 responses. Academic productivity was higher at institutions with more dedicated imaging personnel, personnel with dedicated protected academic time, and advanced imaging fellows. Academic productivity did not correlate with clinical productivity and was not significantly affected by the presence of dedicated research sonographers. The satisfaction level of laboratory medical directors was related to dedicated administrative time and an administrative stipend. The majority of administrative roles were tasked to the laboratory medical director with support of the technical director. FCU was listed as a hospital privilege at four institutions (13%). Twenty-two (58%) were training FCU providers in one or more subspecialties. FCU was not associated with clinical or academic productivity. CONCLUSIONS: This third survey gathered supplemental data to complement the clinical productivity data collected from the first two surveys. Together, the results of these surveys further describe the range of factors that can affect North American academic pediatric echocardiography laboratories.

Validation of the English version of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in cats.

BACKGROUND: A scale validated in one language is not automatically valid in another language or culture. The purpose of this study was to validate the English version of the UNESP-Botucatu multidimensional composite pain scale (MCPS) to assess postoperative pain in cats. The English version was developed using translation, back-translation, and review by individuals with expertise in feline pain management. In sequence, validity and reliability tests were performed. RESULTS: Of the three domains identified by factor analysis, the internal consistency was excellent for 'pain expression' and 'psychomotor change' (0.86 and 0.87) but not for 'physiological variables' (0.28). Relevant changes in pain scores at clinically distinct time points (e.g., post-surgery, post-analgesic therapy), confirmed the construct validity and responsiveness (Wilcoxon test, p < 0.001). Favorable correlation with the IVAS scores (p < 0.001) and moderate to very good agreement between blinded observers and 'gold standard' evaluations, supported criterion validity. The cut-off point for rescue analgesia was > 7 (range 0-30 points) with 96.5% sensitivity and 99.5% specificity. CONCLUSIONS: The English version of the UNESP-Botucatu-MCPS is a valid, reliable and responsive instrument for assessing acute pain in cats undergoing ovariohysterectomy, when used by anesthesiologists or anesthesia technicians. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction.

OBJECTIVE: To describe the technique for performing a coccygeal epidural injection of local anesthetic to facilitate catheterization in male cats with urethral obstructions using low-dose sedation. SIGNIFICANCE: Prompt diagnosis and relief of urethral obstructions is important as many cats may have developed marked metabolic abnormalities at the time of presentation. General anesthesia in these patients may be associated with significant risk for complications. Pain management is also an essential treatment goal, and this technique relieves urethral and penile pain during the unblocking process. CONCLUSION: Coccygeal epidurals can be used safely to provide analgesia to the penis and urethra and to the authors' knowledge, is a novel treatment modality to aid in the relief of urethral obstructions in male cats.

Management of chronic soft tissue pain.

Soft tissue pain is, by default, an entity of most of the other structures in the body besides bone. This includes muscle, fascia, tendons, ligaments, cartilage, synovium, fibrous capsules, organs, and nerves. Soft tissue pain is often overlooked because it is not as easy to diagnose as pain involving bony structures. However, soft tissue pain can be just as debilitating as pain from bony structures. Treatment of soft tissue pain includes a variety of pharmacologic and nonpharmacologic techniques, and these are discussed in this article.

A multimodal approach to management of suspected neuropathic pain in a prairie falcon (Falco mexicanus).

An adult male prairie falcon (Falco mexicanus) was presented for evaluation and treatment of self-inflicted wounds along the right proximal patagium. The bird had started self-traumatizing approximately 1 month after fracturing the right metacarpus, although the fracture had stabilized, surface wounds had healed completely, and treatment with a nonsteroidal antiinflammatory drug had been administered. The bird was treated with gabapentin (11 mg/kg p.o. q12h), ketamine (0.5 mg/kg i.m. q24h), and low level laser therapy (LLLT) (<5 mW, 630-680 nm, 5-second application per site) for 3 weeks, but, despite initial improvement, new self-inflicted wounds appeared at the same site. Approximately 1.5 months later, a radial and medianoulnar nerve block was performed by using bupivacaine (2 mg/kg) and medetomidine (0.5 microg/kg). In addition, the dosing interval of ketamine was increased to q12h, and the dose of gabapentin was increased 7.5-fold. A higher energy and wavelength of LLLT (1040 mW, 830 nm, 2 J/cm2) was applied once to the injured region and fracture site, then the original LLLT protocol was applied once daily. After 2.5 months, the wounds healed completely and no further mutilation took place. Once deemed ready for release, the falcon was returned to the wild after 181 days in captivity. This is the first reported application of successful multimodal analgesia in a raptor with uncontrolled neuropathic pain.

Successful biphasic transthoracic defibrillation of a dog with prolonged, refractory ventricular fibrillation.

OBJECTIVE: To describe a case of spontaneous ventricular fibrillation in a dog in which biphasic defibrillation was life saving. CASE SUMMARY: Ventricular fibrillation occurred in a 7-year-old female Australian Heeler during recovery from anesthesia following pacemaker implantation. Resuscitative efforts including immediate delivery of transthoracic monophasic defibrillation shocks of escalating energy and administration of vasopressors were unsuccessful. However, a single biphasic shock restored sinus rhythm despite prolonged duration of the arrhythmia. NEW OR UNIQUE INFORMATION PROVIDED: This case suggests greater efficacy of biphasic defibrillation compared with traditional monophasic defibrillation. In this dog the newer, biphasic technology was life saving after monophasic shocks failed repeatedly to terminate ventricular fibrillation.

Changes in colloid osmotic pressure as a function of anesthesia and surgery in the presence and absence of isotonic fluid administration in dogs.

OBJECTIVE: To determine how a combination of anesthetic drugs; including pre-medication, induction agents and inhalational agents; affect colloid osmotic pressure (COP) in the presence and absence of isotonic fluid administration. Secondarily, to determine if changes in total plasma protein (TPP) correlate with COP in anesthetized patients. STUDY DESIGN: Prospective, randomized clinical study. ANIMALS: Ten female dogs, 4 months to 4 years of age and >8 kg undergoing elective ovariohysterectomy. METHODS: All dogs were anesthetized in a similar fashion. After induction, five dogs received lactated ringer's solution (LRS) at 10 mL kg(-1) hour(-1) and five dogs received no fluid therapy during anesthesia. Blood samples were collected prior to pre-medication, prior to induction, immediately post-induction/prior to the inhalational agent, 30 minutes post-induction, at the time of recovery and 45 minutes post-discontinuation of inhalant. TPP and COP were measured from each sample. RESULTS: Administration of fluids resulted in a decrease in COP and TPP over time that did not return to baseline by 45 minutes after recovery. Anesthesia without the administration of fluids also resulted in a significant decrease in COP over time, that was rebounding by recovery (but still significantly less than baseline). TPP had variable correlation with COP at different time points with or without fluid administration. CONCLUSIONS AND CLINICAL RELEVANCE: Anesthetic drugs alter COP similarly in the presence and absence of isotonic fluids. These changes in COP did not have a simple relationship to TPP and so the latter could not be used to predict COP in this patient population.

Heterotopic implantation of a porcine bioprosthetic heart valve in a dog with aortic valve endocarditis.

CASE DESCRIPTION: A 5-year-old male German Shepherd Dog was evaluated because of a 5-month history of progressive lethargy, weight loss, and heart failure. CLINICAL FINDINGS: On physical examination, bounding femoral pulses and systolic and diastolic murmurs were detected. Echocardiography revealed severe aortic valve insufficiency (AVI) and a large vegetative lesion on the aortic valve consistent with aortic valve endocarditis. The AVI velocity profile half-time was 130 milliseconds; the calculated peak systolic pressure gradient across the aortic valve was 64 mm Hg. Left ventricular diameter during diastole was 63.6 mm (predicted range, 40.2 to 42 mm) and during systole was 42.9 mm (predicted range, 25.4 to 27 mm). Systolic, diastolic, and mean arterial blood pressures were 120, 43, and 65 mm Hg, respectively. TREATMENT AND OUTCOME: To palliate severe AVI, the descending aorta was occluded (duration, 16.75 minutes) and heterotopic implantation of a porcine bioprosthetic heart valve in that vessel was performed. After surgery, systolic, diastolic, and mean arterial blood pressures were 115, 30, and 61 mm Hg, respectively, in the forelimb and 110, 62, and 77 mm Hg, respectively, in the hind limb. Within 6 months, the AVI velocity profile half-time had increased to 210 milliseconds, indicating diminished severity of AVI. After 24 months, the dog was able to engage in vigorous exercise; no pulmonary edema had developed since surgery. CLINICAL RELEVANCE: Heterotopic bioprosthetic heart valve implantation into the descending aorta during brief aortic occlusion appears feasible in dogs and may provide substantial palliation for dogs with severe AVI.

Successful implementation of universal woman abuse inquiry.

OBJECTIVE: This study investigated a year-long professional development strategy to improve Public Health Nurse (PHN) documented abuse inquiry among low-risk postpartum women. Strategies included workshops and small group work at regular intervals. DESIGN: A retrospective chart audit of cross-sectional data collected as part of the Healthy Babies/Healthy Children Program was conducted 1 year before and after the introduction of the Routine Universal Comprehensive Screening (RUCS) Program. SAMPLE: Charts of all postpartum women who lived in one Ontario county (Canada) and who received a PHN home visit were reviewed (pre-RUCS, n=1,151; post-RUCS, n=1,193). MEASUREMENT: Information regarding mother's age group and parity, month of PHN visit, abuse inquiry, and whether or not the woman was a single parent was abstracted. RESULTS: Originally, there was documentation of abuse inquiry on only 0.8% of low-risk postpartum client charts. Women aged <20 years and single parents were significantly (p<.001) more likely to be asked, suggesting case-finding among PHNs. Post-RUCS abuse inquiry increased to 20.5% with no demographic differences between those groups asked. CONCLUSION: Policy changes providing specific expectations and documentation cues can improve routine abuse inquiry. New policies can be effectively combined with existing programs and infrastructure, facilitating the longer term success of new initiatives.

Nursing the social wound: public health nurses' experiences of screening for woman abuse.

The purpose of this study was to describe the experiences of public health nurses (PHNs) who screen for woman abuse within their clinical practice. Semi-structured, in-depth interviews were conducted with 11 PHNs. There was a great deal of variability in participants' level of experience in working with abused women. The results reveal that nurse readiness is an important factor in screening for woman abuse. The authors describe a number of steps participants appeared to grapple with in order to become comfortable working with abused women, including coming to terms with abuse, asking the question, bearing witness, and "walking with" the client. As the PHN became increasingly comfortable working with abused women, she came to redefine success. Her client's personal growth over time, rather than the single act of leaving an abusive relationship, now defined a successful client interaction. The authors also discuss implications for practice that arise from these accounts.

Pharmacokinetics and anesthetic and cardiopulmonary effects of propofol in red-tailed hawks (Buteo jamaicensis) and great horned owls (Bubo virginianus).

OBJECTIVE: To determine induction doses, anesthetic constant rate infusions (CRI), and cardiopulmonary effects of propofol in red-tailed hawks and great horned owls and propofol pharmacokinetics in the owls during CRI. ANIMALS: 6 red-tailed hawks and 6 great horned owls. PROCEDURE: The CRI dose necessary for a loss of withdrawal reflex was determined via specific stimuli. Anesthesia was induced by IV administration of propofol (1 mg/kg/min) and maintained by CRI at the predetermined dose for 30 minutes. Heart and respiratory rates, arterial blood pressures, and blood gas tensions were obtained in awake birds and at various times after induction. End-tidal CO2 (ETCO2) concentration and esophageal temperature were obtained after induction. Propofol plasma concentrations were obtained after induction and after completion of the CRI in the owls. Recovery times were recorded. RESULTS: Mean +/- SD doses for induction and CRI were 4.48 +/- 1.09 mg/kg and 0.48 +/- 0.06 mg/kg/min, respectively, for hawks and 3.36 +/- 0.71 mg/kg and 0.56 +/- 0.15 mg/kg/min, respectively, for owls. Significant increases in PaCO2, HCO3, and ETCO2 in hawks and owls and significant decreases in arterial pH in hawks were detected. A 2-compartment model best described the owl pharmacodynamic data. Recovery times after infusion were prolonged and varied widely. Central nervous system excitatory signs were observed during recovery. CONCLUSIONS AND CLINICAL RELEVANCE: Effects on blood pressure were minimal, but effective ventilation was reduced, suggesting the need for careful monitoring during anesthesia. Prolonged recovery periods with moderate-to-severe excitatory CNS signs may occur in these species at these doses.

Teen sexuality. Reaching out in the malls.

BACKGROUND: Existing sexual health programs have not significantly reduced teen pregnancies or sexually transmitted diseases. A more creative approach is needed. METHODS: An assessment of 539 teens in one Ontario city was conducted to identify knowledge about and use of birth control, comfort in discussing sexual health, and preferred sites, providers and methods of service delivery. RESULTS: Knowledge of, and comfort discussing, birth control was not associated with frequency of use but was associated with grade. Adolescents were less comfortable discussing sexual health with teachers than health professionals. Over time, comfort increased with health professionals, but not teachers. Sexually active teens reported willingness to attend mall-based clinics. CONCLUSIONS: Using birth control appears to be maturational given its association with grade. Since teens were consistently less comfortable with teachers, providing sexual health services in schools is likely ineffective. Teens may respond to clinics in creative settings such as malls.

Clinical pain management techniques for cats.

Although pain management is an emerging and popular topic in veterinary medicine, use of analgesics in cats has received little attention relative to their canine counterparts. Some of the difficulty lies in assessment of whether or not a cat is in pain. Simple observation of a cat in a cage relies upon overt expression of pain, and is often inaccurate. Pain scales have been developed that allow a semiquantitative evaluation of the degree of pain an animal may be experiencing. However, treating pain based upon observation of the painful state is less effective than anticipating and preemptively treating pain. This article reviews specific methods for preemptively treating and alleviating pain in the cat. The traditional approach to pain management involves drug administration. Specific categories of agents used in cats include opioids, nonsteroidal anti-inflammatories, or alpha-2 agonists. Other modalities of pain management, which are also reviewed, include use of local anesthetic drugs for local and regional analgesia, as well as acupuncture.

An evaluation of apnea or spontaneous ventilation in early recovery following mechanical ventilation in the anesthetized horse.

OBJECTIVE: To compare arterial oxygen and carbon dioxide tensions in apneic and spontaneously ventilating horses recovering from anesthesia. STUDY DESIGN: Randomized clinical trial. ANIMAL POPULATION: Forty-two healthy horses averaging 466 ± 106 kg and 6 ± 5 years of age. METHODS: Anesthetized horses undergoing a variety of surgical procedures and receiving positive pressure ventilation (IPPV) were divided into two equal groups. One group was allowed to return to spontaneous ventilation prior to disconnection from the anesthetic circuit (weaned). The other group remained apneic during transport to a recovery stall. Arterial blood gas data were collected at five time points: 20 minutes before moving to a recovery stall (t = - 20); at the time the anesthetic circuit was disconncted (t = 0); at 3 and 5 minutes post-disconnection (t = 3 and t = 5) and at the time of the first spontaneous breath (t = sv). The data were analyzed using an anova method for repeated measures and paired, two-tailed t-tests. Significance was assumed when p < 0.05. RESULTS: The apneic group took a mean of 5 minutes 18 seconds (± 135 seconds) before starting spontaneous ventilation. This group maintained significantly higher PaO2 levels at intermediate time points (t = 0 and t = 3) but no difference was noted after 5 minutes. PaCO2 levels were higher in the weaned group at time 0 minutes, returning to a comparable level to the apneic group at t = 3 minutes. CONCLUSIONS AND CLINICAL RELEVANCE: Horses can survive a short period of apnea during transport from the surgery suite to recovery stall and may benefit from a reduced incidence of transient hypoxemia compared with spontaneously ventilating horses. This information has practical implications for the anesthetist evaluating the options for discontinuing IPPV when horses are moved to a recovery stall.