Tag Archives: Pain Management

Rabbit and Guinea Pig Abscesses ( Dr. Gottleib)

Here at Ocean County Veterinary Hospital Group (OCVH) we find that one of the most frustrating problems for rabbit and guinea pig owners is when a seemingly healthy pet develops an abscess – a pocket of infection and pus. Underlying dental disease is the most common reason these abscesses form. An abnormal tooth or malformation of the mouth will frequently lead to abscesses. Rabbit and guinea pig teeth continue to grow throughout the animal’s entire life, so it is important that they always have hay available. Chewing hay helps keep their teeth properly ground down. Unfortunately, genetics also plays a role, so even with a proper diet, acquired dental disease and abscesses are not always preventable.

            There are some other ways for abscesses to occur in rabbits and guinea pigs. Trauma is a frequent underlying cause. This can be anything from a fall to a sharp piece of a cage abrading or puncturing the feet or body. And abscesses can occur anywhere in the body if the infection enters the blood stream and lymphatic system. Untreated, these lesions will many times be fatal.

 Recently, a little guinea pig named Jack came to visit us at OCVH.. Jack, a 10-month old male, presented for two swellings under his chin. Upon examination, we found that the swellings were actually abscessed lymph nodes. We immediately took him to surgery to lance and drain the infected lesions. He recovered well and was placed on oral antibiotics to help fight the infection. With many guinea pigs and rabbits this relatively minor procedure alone is enough to cure the problem.  Unfortunately, recurrence is not uncommon due to the huge load of bacteria in the system and other complicating factors.

              Jack did happen to have a recurrence of the swellings about 2 weeks later. This time we needed to perform a more complex procedure to remove Jack’s lymph nodes “en bloc”- which means to completely cut out all of the infected lymph node intact. The surgical sites were packed with a blend of antibiotics and other natural ingredients to promote healing.  Jack continued to take antibiotics and his owners were instructed how to flush the areas to keep them clean and promote healing. Jack did very well following this procedure, but unfortunately recurrence is still possible.

            Early detection is the key to a successful outcome for these types of cases.  By recognizing abscesses early we can remove small pockets of infection before they spread or become more invasive. It gives us the best chance at avoiding recurrence and reducing the pet’s discomfort. For this reason regular visits with your guinea pig and rabbit companions are highly recommended. During the examination, we can get a clear view of your pet’s teeth and oral cavity, as well as palpate for the presence of any abscesses that may be cropping up. We can also trim or file overgrown teeth before they cause pain or abscesses to form.

 

 So remember, lots of hay, careful observation and rapid intervention whenever you suspect a problem.

Thanks for entrusting us with the care of your rabbit and guinea pig family members!

Dr. Gottlieb

“My Pet Is In Pain. Can I Just Use….” ( Dr. Danowitz)

As veterinarians, we are frequently asked by clients about using over-the-counter human medications to manage their pet’s pain and discomfort.  Unfortunately, the answer is almost always, “No, it is just not safe.”  Many common human anti-inflammatory medications can cause serious gastrointestinal ulceration, bleeding, and even kidney failure. Aspirin, Ibuprofen and Naproxen are currently the most frequent medications requiring hospitalization of pets as result of well-intentioned pet owners not realizing how dangerous these drugs can be.

 

 

ASPIRIN (acetylsalicylic acid)

Aspirin is probably the most common human medication that we are asked about, and that owners go ahead and administer to their pets without consulting us first.  Aspirin inhibits an enzyme called cyclooxygenase, which is involved in the production of inflammatory chemicals called prostaglandins. Unfortunately there are lots of different cyclooxygenase enzymes that perform different functions in the body, and aspirin affects them all.  Although administering aspirin to your dog (attempting to treat arthritis, for example) may result in mild pain relief, it is frequently associated with the following side effects:

  1. Nausea, vomiting or diarrhea
  2. Stomach or intestinal ulceration and bleeding, which can lead to decreased appetite, vomiting, and  black, tarry stool referred to as “melena”
  3. Reduced blood supply the kidney, possibly leading to kidney failure
  4. Reduced ability to clot blood.

Whether an aspirin is buffered or not makes no difference to the dog or cat. A study performed at the Virginia-Maryland Regional College of Veterinary Medicine published in 1999 compared the effects on the stomach and intestine between buffered aspirin and 2 veterinary non-steroidal anti-inflammatories, Rimadyl and Etogesic.  Different dogs were given these three medications and then their stomachs and intestines were examined with an endoscope at certain intervals after administration. Of the dogs that received buffered aspirin, 100% experienced significant stomach and intestinal bleeding. Very few of the dogs that received the either of the two veterinary drugs sustained any bleeding, and when present it was mild compared to the aspirin group.

Aspirin was once believed to be an adequate OTC pain reliever for our canine companions, and so-called “dog aspirin” can still be found on the shelves at some pet stores. Unfortunately, it is not as effective in controlling pain as the veterinary approved drugs and certainly not as safe.

Cats are particularly sensitive to the toxic effects of aspirin. Even small doses can cause fatal reactions.

IBUPROFEN (Advil, Motrin), NAPROXEN (Aleve, Naprosyn)

Available as a human pain-reliever in the US since 1974, Ibuprofen is one of the most common items found in the medicine cabinets across the country.  Like aspirin, Ibuprofen and Naproxen are non-steroidal anti-inflammatory drugs that are non-selective inhibitor of cyclooxygenase. Both of these medications are even MORE toxic than aspirin to dogs, and incredibly toxic to cats.  The side effects of ibuprofen and naproxen include:

  1. Nausea, vomiting, diarrhea or inappetence
  2. Stomach or intestinal ulceration and bleeding, which can lead to decreased appetite, vomiting, and  black, tarry stool referred to as “melena”
  3. Kidney Failure
  4. Neurological Signs: tremors, seizures, coma

Treatment for Ibuprofen / Naproxen ingestion depends on the dosage received, species, timing of the event, and other factors, but can include: inducing vomiting, administering a compound called activated charcoal to prevent continued absorption in the gastrointestinal tract, hospitalization and IV fluid diuresis, as well as supportive care for vomiting, stomach and intestinal ulceration, and decreased appetite.  Without prompt veterinary care, administration of Ibuprofen to your dog or cat could result in death.

It is so difficult to see our beloved pets in pain, and it is human nature to want to relieve them of any discomfort. The veterinary industry has seen tremendous advancements in different treatment modalities to combat pain control over the past 5-10 years and not all involve medications. (Ask us about K-Laser therapy). We have been able to greatly improve the quality of life of our patients.  If you feel that your pet is in pain, please call one of our veterinarians to discuss the many treatment options or schedule an examination. Please always consult us before administering any human medications, or animal medications not previously prescribed specifically for your pet!

 

Billy Danowitz  DVM

Is your dog having knee problems? (by Dr. Jenna Koenigstein)

Medial Patellar Luxation (MPL) in Dogs

“Trick knees”, more properly termed medial patellar luxations, are a relatively common finding on physical examinations here at OCVH and in most veterinary practices of small breed dogs.  In many cases, it is an incidental finding during a routine exam, while in other cases it is found when a dog comes in for sudden limping.  When found on routine physical exam, veterinarians will mention it as a finding but may not go into much detail since it is not usually a cause for concern. But since it is so common, here is some additional information about the condition and what, if anything should be done about it.

What is it?

The patella is the fancy name for the knee cap.  It is attached to the tendon of the quadriceps muscle in the front of the thigh and sits in a groove of the femur (thigh bone). The function of the patella is to act like a pulley and to facilitate the bending actions (flexing and extending) of the knee.  The term “patellar luxation” means that the knee cap has slipped out of its normal position within the groove of the femur, most often toward opposite leg (medially).  Sometimes it may slip toward the outward direction, which would be called lateral patellar luxation, but this is much less common.  While patellar luxation can be seen in any breed, smaller breed dogs are much more prone to it.  About 50% of affected dogs have the abnormality in both knees.

What causes it?

Medial patellar luxation (MPL) is most often due to a congenital (inherited) abnormality and is usually present from a young age.  The groove in which it resides may be too shallow or an abnormal rotation of the shin bone may cause the attachment of the tendon to be more to the side.  In either case, the patella is tends to pop out of place with normal motion of the leg. Trauma or injury can also cause luxation but this is relatively rare.

Clinical signs

In most cases, there is no obvious sign to the owner that a pet has this condition.  Some owners will note that the pet will occasionally hop or skip on one leg when running and then return to normal without ever acting painful, indicating that the patella has shifted out of groove but then popped back into place.  Some dogs may become lame during exercise if the patella shifts and does not return to normal position, causing discomfort and inflammation. Long term effects of frequent displacements can lead to arthritis in some pets and may make them more prone to injury of ligaments in the knee.

Types of Luxation

Patellar luxation is graded on a scale of 1 to 4, with higher numbers indicating more severe luxation.

Grade I – Patella can be manually moved out of groove during examination but immediately returns to normal position.   These dogs are unlikely to show lameness.

Grade II – Patella is able to be easily manipulated out of place but does not return to correct location once pressure removed.  These cases are more likely to show mild signs of lameness.

Grade III – Patella is always luxated, can be slipped back into place but immediately re-luxates.  These dogs show more persistent lameness.

Grade IV – Patella always out of groove and cannot be put back in place.  These dogs will have significant lameness and cannot straighten knee. They may have bow-legged appearance.

 Diagnosis

MPL can be easily diagnosed on routine orthopedic examination.  Radiographs or other imaging modalities may be needed to determine the extent of abnormalities (structural deformities, depth of femoral groove, etc). 

 

Treatment

Those pets with Grade I or II luxation that rarely or never show any clinical signs are unlikely to need surgical treatment.  For those with Grade II or greater that show more persistent lameness, surgery can help to correct the underlying abnormalities.  If both legs are equally affected, most surgeons recommend correcting one leg at a time and allowing time for the first to heal prior to correcting the second (at least 8 weeks).  The exception to this may be a dog that is still growing as correcting one at a time may lead to conformation changes if the bones are still growing.

 

Trochlear Modification – this surgical correction is meant for those small breed dogs with a shallow groove.  The goal is to deepen the groove by removing some of the bone below the cartilage, then replacing the cartilage to keep the smooth surface.

 

Tibial Tuberosity Transposition – this is a more complicated surgery which is meant to change the alignment of where the patellar tendon attaches to the top of the tibia (shin bone) to prevent the patella from being pulled to the side.  The tibial tuberosity (crest where the ligament attaches) is removed and pinned in a different location to adjust the pull on the patella.  In some severe cases, the entire bone must be cut and realigned.

 

Post- operative care

In simple cases of trochlear modification, 3-4 weeks of rest is sufficient for recovery.  With more complicated surgery, a longer period of confinement, possibly up to 8 weeks or more, may be recommended.  Some of these dogs also benefit from physical therapy.

 

Need More Information?

If you suspect your dog may have patellar luxation or another orthopedic problem please contact one of our veterinarians or schedule an examination.

 

Jenna Koenigstein DVM

 

 

Shining A Light On Your Pet’s Pain Relief (Dr. Pearlman)

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If pets could talk, many would probably ask for K-Laser therapy and to have those treatments done at OCVH, of course!  Class 4 (the most advanced) therapy Lasers are used to treat arthritis, fractures, ear infections and many other conditions that affect our pets. Laser treatments have been used in human medicine in Europe for over 20 years and were approved for use in the United States about 10 years ago. Medical doctors, chiropractors and physical therapists all use the K-Laser to help their patients. Professional sports teams have also started using this healing modality.

 

Laser treatments work by delivering energy in the form of light waves past the fur and skin into deeper tissues where healing is needed – for example, an arthritic hip joint in an older dog. Arthritis occurs because hip joint has lost much of its joint fluid for lubrication and some of the cartilage has been replaced by bone. Why K-Laser?  All of these changes lead to one thing – pain!!  The Laser helps the body heal more quickly and dramatically reduce pain at the source.  Some dogs with arthritis or back pain that needed assistance to get into the clinic for the first few Laser sessions and have been able to walk on their own again.  The Laser also has many other uses such as wound healing, soft tissue sprains, infections, gingivitis and more.

 

At OCVH we like use the K-Laser because it is a pain-free, drug-free treatment option for many degenerative conditions in our pets. Typically a Laser session takes around 5 minutes for each area to be treated. For a chronic condition like arthritis, pets would likely need to have treatments several times each week for the first 2-3 weeks, and then the frequency of visits decreases. Some pets continue to have treatments on an as needed basis to maintain their comfort. During therapy you will be with your pet and you get to wear fancy, protective safety goggles.  Pets very quickly learn that the Laser does not hurt and actually helps them feel better. My own dogs love the extra TLC. It feels good!

 

I have been able to witness the beneficial effects of this treatment on my very own dogs. Ginger, Sara, and Ernie have all gotten K-Laser treatments and are still doing well. Ginger, is 11 years and weighs 90 pounds.  She tore one of the cruciate ligaments in her knee – this is the most common orthopedic injury in large dogs. She had surgery on her knee over a year ago. We used the K-Laser on her injured leg as part of her rehabilitation program. She is able to walk normally now, and still gets the treatments once per week. Sarah, our 8 year old German Shepherd dog has one of the worst cases of hip dysplasia (her hips have been this bad since she was the age of 5 when we first rescued her), yet she is able to run and play without any arthritis drugs. Ernie came to us with a broken back and although he is still paralyzed in his back legs, he is pain free and we are hopeful that he will walk someday – with the help of the K-Laser.  Thanks to the K-Laser my dogs are living a better quality of life with more walks, more play, and lots more happy pain-free time.

 

There is hope, if your pet is in pain he or she may be helped by Laser therapy. Contact one of our staff members to schedule an appointment for a consultation to get started with K-Laser therapy. Your pet will thank you!

Laurie Pearlman DVM

You CAN manage arthritis in your pet! (By Dr. Jenna Koenigstein)

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Nikki’s story

This lovely lady is Nikki a patient at Ocean County Veterinary Hospital (OCVH) . She is a very happy 11 month old lab who loves to eat and swim but is otherwise a bit lazy.  One day a few months ago, she was outside playing with her “sister” and suddenly started limping badly on her right front leg.  X-rays of her legs showed that she had an inherited condition called Elbow Dysplasia in both of her elbows, and sadly was already developing arthritis.  Although surgery removed the congenital defects in her elbows and helped her tremendously, it could not reverse or prevent the early arthritis which will continue to get worse with time.

Stories like this are common, but not what most people think of when they think of arthritis.  The sad truth is that many young dogs are at risk for developing arthritis, whether from developmental conditions like hip dysplasia, elbow dysplasia or injuries like torn ligaments (ACLs) in the stifles (knees).  For pets that are in pain and having difficulty getting around, medications like NSAIDs (non-steroidal anti-inflammatories, for example, Rimadyl) are needed to make them feel better.  Fortunately, for long-term management of arthritis, there are many other things that can be done to improve the overall comfort and slow the progression of arthritis in both young and old dogs, particularly when the arthritis is diagnosed in its early stages.  Unfortunately, many times it is not addressed until the arthritis has reached the point where the pet is consistently limping.  The true goal of arthritis management should be focused on preventing pain and slowing progression of the process.  Here are some ways to achieve this goal.

Weight management

The single most important thing you can do as a pet parent with an animal with arthritis is keep their weight under control.

Extra pounds will not only make it even more difficult for dogs to get up and down but can also speed up the progression of arthritis.  Decreasing caloric intake, whether by decreasing the quantity fed or by switching to a diet food (either lower calorie or prescription) and increasing exercise will help you to see results at home.  Often the amount that your pet needs to eat to meet their metabolic needs is far less than you think they should be eating.  The feeding recommendations on the bags of food are just generalizations and do not take into account individual variation in metabolism, and may be far too much for your individual pet, especially if they are not very active. What is your pet’s body condition? See the chart below. Ask your veterinarian for special diets that can help your pet lose weight more easily.

Adequan

Adequan in a unique injectable medication the helps prevent the cartilage in joints from wearing away.  The goal of this treatment is to keep the cartilage healthy and intact so that the bones in the joint cannot rub on each other.  It is initially given twice a week for 4 weeks and then as needed.  Owners can be taught to give the injections at home (very easy!).  Most owners have noticed a drastic improvement in their pet’s mobility after starting Adequan and many have been able to decrease or altogether stop giving oral pain medications.

Oral Supplements

There are numerous oral supplements on the market that can help to improve mobility.  Glucosamine and chondroitin are the most popular supplements on the pharmacy shelves and many owners have noted improvement in their pet’s comfort while on these.  There are many companies making these supplements, which can be purchased both at veterinary hospitals and over the counter (OTC).  Caution must be exercised with OTC products as they frequently do not have the levels of glucosamine and chondroitin that are claimed on the label, and some contain potentially harmful components such as salicylic acid (metabolite of aspirin) which increases the risk of stomach ulceration. We recommend using Cosequin or Dasuquin.

Another supplement recommended in animals with arthritis is Duralactin.  This contains Microlactin, a dried milk protein from hyper-immunized cows that works at a cellular level to reduce inflammation and prevent subsequent tissue damage.   It can be used in conjunction with a glucosamine and chondroitin supplement such as Dasuquin to reduce inflammation and improve overall mobility.

Rehab/exercise

Proper exercise is essential for the arthritic pet, as it is crucial to maintain as much muscle mass as possible to support the abnormal joint.  Massage and gentle flexion/extension exercises may also help.   In later stages of arthritis, facilities specializing in canine rehabilitation and physical therapy can develop an exercise plan for your canine companion.

 Nikki walking on the underwater treadmill.

 

Physical Analgesia

Laser therapy utilizes the benefits of photobiomodulation to promote tissue healing and reduce inflammation.  We have had a lot of success at OCVH with the K-Laser not only in managing arthritis, but also with infected wounds, soft tissue injuries, and post-operative healing.

Several other methods of promoting pain relief have been used in management of arthritis in pets, including acupuncture, transcutaneous electrical stimulation (TENS), shock wave therapy, and many others.  Ask your veterinarian if you are interested in pursuing these alternative methods of reducing inflammation and pain associated with arthritis.

When pets with evidence of early arthritis are managed with the long-term goal of slowing down progression of the disease rather than simply immediate pain relief, we have the chance of giving them a better quality of life for much longer.  As for Nikki, since her surgery she has been on a diet (3.6 pounds down so far!), and has  started both Adequan and K-Laser therapy in addition to a glucosamine and chondroitin supplement (Dasuquin).  Despite being in the early stages of arthritis, taking these steps now should significantly slow down the progression of the disease and keep her happy and comfortable for a long time to come.

 

 

Is it too late for New Year’s Resolutions? (Dr. Lorri Mitchell)

We are well into 2013 now and one may wonder, how well are the New Year’s Resolutions coming along? Some of us may be doing well while others may have let them slide. So, instead of fretting about our own personal resolutions, how about making a few to benefit your pet?

 

 

Recently I have been reading some articles about resolutions for our pets and I wonder if any of our readers have made resolutions aimed at making our companions happier and healthier?

I would like to take a moment to share a few resolutions that maybe you can work into your family.

1. Protection. We all protect our pets. Keep them in fenced yards, on leashes or prevent them from escaping outside but is there anything else we can do? Keeping identifying tags on them is another step. Make sure they have current contact information on them too. For those pets (or owners) who don’t like dangling tags there are always the embroidered collars where your info is directly sewn onto it. Microchipping is another way to get extra protection in case your pet goes missing. If your pet is picked up by animal control, brought to a veterinary hospital or a shelter they will be scanned and if chipped they will contact the owner. Already have a chip? Make sure your current contact info is registered with the manufacturer. It is so disappointing to us when we are lucky enough to find a chip in a lost animal only to call the company and find out it has never been linked to an owner. (The Res-Q chips we use have a back-up registry to our hospital.) Since their invention, microchip companies have reunited more than 100,000,000 pets and owners! Keep current copies of vaccine records, documents of any chronic diseases your pet has and medications they are taking in case of emergency.

 

2. Prevention. Resolve to keep up on preventative care. Yearly physicals (twice yearly for those with chronic conditions or senior pets). Start brushing teeth! We can help you develop a home care program for your pet. Do some early detection blood work. Keep up with monthly Heartworm prevention and flea and tick control. The maker of Heartgard has created a free app to help you remember when it is time to give the monthly tablet. Go to www.heartgard.com to download. Use the reminder to do your flea and tick medicine the same day!

 

3. Diet and exercise. The category we all hate! Vow to feed well and use portion control. We can get your pet set up with a weight reduction plan if you need one. Hills has just introduced a new prescription diet, “Metabolic Advanced Weight Solution,” for obese dogs and cats that promises easier weight loss with lasting results. Do homework on the foods you feed including treats as there have been too many recalls in the last few years. Resolve to do more walks or play more laser light chasing or whatever gets your pal going.

 

4. Spend more time with our pets. If given the chance, this is the one I think our pets would choose.  Pledge 10 minutes a day to: brush them if they enjoy it, belly rubs, road trips and lots of cuddles in the lap – it’s been shown to reduce people’s heart rate and blood pressure so we can benefit too. Win Win!

 

5. Get a New Look!
In 2013, give your pet the gift of glam! A regular grooming regimen will make your pet feel proud, pampered and healthy.

 

Now that we know what we need to do in 2013 for our pets, let’s see what it would look like if our pets wrote their own New Years Resolutions…

 

It might look like…..

–          Don’t get in the trash

–          Drink from my bowl not the toilet

–          Play more ball, chase more mice/squirrels

–          I will go willingly to the vet as they tell me it is in my own best interest

–          Let them brush my teeth                                                 

–          Perfect  my begging eyes

–          Improve my manners

–          I will come when I am called

–          Try to stay off the furniture

 

 

 

 

Celebrity Pets

Some celebrity pet owners were asked what their resolutions were for their pets. Actress Hilary Swank responded that her two dogs are so great that she vows to take them everywhere she goes including interviews. Bob Barker wishes his rabbit would use his litter box every time not just when it’s convenient! Glee actress Lea Michele says her cat Sheila needs to resolve to stop going into the bathroom and taking all the cotton balls out of the jar and scattering them all over.

I hope this New Year finds all of you and your pets well and happy. Again, if you wish to speak with our staff about teeth brushing, wellness programs, weight loss or micro chipping contact us anytime. Happy Belated New Year!