Vet360 Vol 4 Issue 4 August 2017 Vet 360 - Page 24

Article sponsored by Petcam ® SURGERY absolute cage rest is to tell them that for two weeks, the dogs have to be in “prison.” No exceptions. That means in the kennel at all times and carried outside for bathroom breaks. They don’t get time to sniff around. If they don’t pee, they go back in the house and you can try again later. The reason two weeks is required is that if there is a tear in the annulus, then two weeks are required to heal that tear and prevent additional nuclear material from being extruded or, in layman’s terms, “squished out.” After the first two week two additional weeks of re- stricted activity are required with specific guidelines regarding physical rehabilitation for a total of four weeks of rest. If you give the client specific instruc- tions, she says, then they are more likely to follow your instructions and continue the cage rest while they are doing the specific exercises. You can start with three- to five-minute walks on a leash and specific physical rehabilitation exercises such as a sit-to-stand, stand- ing and weight-shifting exercises, and passive range of motion. If the patient presents with moderate pain it is recom- mended to give an injectable opioid and a non-steroi- dal anti-inflammatory medication in the hospital. Bu- torphanolis not enough, she says—use oxymorphone, hydromorphone, methadone or morphine. Pain may be managed orally with tramadol (5 to 8 mg/kg) and an anti-inflammatory. Acetaminophen with codeine can be accurately dosed in large breeds but should be compounded for small breeds. Co- deine may also be helpful. With grade 2 disease you can add in gabapentin or methocarbamol (Robaxin®), but Dr Pancotto thinks methocarbamol only helps dogs with visible muscle spasms. Gabapentin can be useful long term in dogs that you think may be predisposed to chronic pain. If the patient is severely painful hospitalisation is rec- ommended with the administration of intermittent opioid injections (every four to six hours) or a po- ly-pharmacy constant-rate infusion (CRI) such as morphine/lidocaine/ketamine with loading doses. If the client is unable to elect hospitalisation because of financial constraints but you feel like this patient would really benefit from injectable pain medication, you can also suggest that the client bring the pet back for injections or apply a fentanyl patch (Durogesic®). The first recheck should be within 48 hours to ensure that the patient is responding to the regimen. If the patient is the same, then you can add in additional medication, acupuncture and heat and ice packing, or consider referral. If the patient is worse than on initial presentation, then the odds of success by continu- ing what you are doing are not good. If the patient is improved, continue as previously directed. These patients are medicated for a full two weeks and then vet360 Issue 04 | AUGUST 2017 | 24 medications are tapered one by one. The second recheck should be at the two-week mark, before the client re-institutes controlled physical activ- ity, and the final recheck should be scheduled around eight weeks. Small steps to get your patients back in the game: Dr. Pancotto recommends starting physical rehabili- tation, including leash walks and massage, after the two weeks of strict rest and then more active physical rehabilitation after four weeks, with a gradual return to full function by eight weeks. In general, avoid all high-impact activities during recovery and counsel your clients to invest in ramps for the couch and the bed. “DOC, I ONLY GOT R2500-00" Don’t be afraid to clarify the client’s actual financial restrictions before you make recommendations. A client that has restricted budget is going to be in a very different position than a client that has sufficient funds. While a client may not be able to afford neuro- surgery, a higher budget gives you a lot more flexibil- ity to practice higher standards of care. Grade 3 Treatment for grade 3 is the same in regards to cage rest and pain control, but now you will need to coun- sel the owners to monitor their pets’ bladder function. Bladder management impacts qualit 䁽́Դ)ѡ͔ѡͥѡ͔ѥ̸)%ѡɔɔٕͥ́ə܁ѥѡɄ)ͥȁ剕酵͡ձɕ͍ɥѼ)ɕѡɕѡɅѕȁȁɕ̴)ͥ%Ё́ɕѼٔѡѥ)ѕ́ɔɕͥѡȸ%ѡ)ٕ݅́ѕ͔ԁɕ͍ɥ)ѡɉѼɕՍ݅ѽ)%Ё́Ё٥͕Ѽɕ͍ɥѡ)́ݥѠȁѽȁɽͥ̀ѥЁɕѡɅ)ѕȤ͔ѡɥͬȁɔ)!хͅѥ́ɕȁɅ̰́)Ѽ͕䁵ѽȁѡȁͥ́ѕɥɅѥ)ȁȁɽչѥѡЁ䁝չ)ѕѕѡݹȸѡɵɔՅ)ɕͥ́Ёհ%ԁٔɅ(́ѡЁ́հ́ȁɕͥ)хͅѥݥѠѕɵѕЁȁݕɥ)ѡѕɥѥ́ЁѼٽᅍɉѥȴ)Յȁɕͥ)%́ЁɐѼх͔ٕѡ)́ɥѥ́ݸѕѡ܁Ѽɕ́ѡ)ȁѼѽȁݡѡȁѡ́她