Abstract
OBJECTIVE
To describe the presentation, clinical findings, diagnosis, treatment, and outcome of cases of trismus (lockjaw) in cold-stunned sea turtles.
ANIMALS
4 Kemp's ridley (Lepidochelys kempii) and 1 loggerhead (Caretta caretta) sea turtle.
METHODS
Cold-stunned sea turtles that presented with difficulty or inability to open their jaw between 2009 and 2023 were included. Information retrieved from medical records included signalment, physical exam findings, diagnostic information, definitive diagnosis via either advanced imaging or histopathology, treatment, and clinical outcome.
RESULTS
Turtles presented between 4 and 48 days into rehabilitation. Three were diagnosed by advanced imaging (CT or MRI), and 2 were diagnosed based on clinical signs and postmortem histopathology. Treatment was multimodal and consisted of antibiotics (5/5), nonsteroidal anti-inflammatories (5/5), vitamin E (3/5), intralesional steroid therapy (3/5), acupuncture (3/5), antifungals (2/5), anti-inflammatory parenteral steroids (2/5), physical therapy (2/5), therapeutic laser (2/5), and supportive feeding via either total parenteral nutrition (1/5), or tube feedings (2/5). Two animals were released, 2 died naturally, and 1 was euthanized.
CLINICAL RELEVANCE
Trismus (lockjaw) is an uncommon finding in stranded cold-stunned sea turtles that can have a significant impact on animal welfare if not diagnosed and treated. This report describes the condition to aid clinical case management and resource allocation in rehabilitation facilities.
Abstract
OBJECTIVE
To evaluate the reliability of preoperative abdominal ultrasonography as a staging tool for dogs with hemoperitoneum due to presumed splenic tumor rupture, focusing on the detection of metastatic lesions in the liver.
ANIMALS
99 dogs from 20 emergency and specialty hospitals across the US.
METHODS
Dogs with nontraumatic hemoperitoneum secondary to splenic tumor rupture were included. A post hoc analysis was conducted on data from a nationwide prospective trial investigating novel treatments for canine hemangiosarcoma. The accuracy of preoperative staging was assessed by comparing ultrasonographic findings with intraoperative observations and histologic findings.
RESULTS
On preoperative ultrasonography, there was a 20% incidence of liver lesions identified, with no association to liver lesions seen during operation. Notably, 22% of liver lesions observed during operation were missed on preoperative ultrasonography. The presence of liver lesions on preoperative ultrasonography was associated with a higher likelihood of a benign splenic tumor diagnosis. There was no association between the identification of liver lesions on preoperative ultrasonography and the presence of metastatic disease on liver biopsy, with a sensitivity and specificity of 19% and 82%, respectively. Additionally, ultrasound had low sensitivity in detecting intra-abdominal lesions beyond the liver and spleen, with 82% of these lesions missed preoperatively.
CLINICAL RELEVANCE
This study challenges conventional perceptions around the approach to staging in dogs with hemoperitoneum. These findings advocate for a reevaluation of the staging approach, with more comprehensive modalities like whole-body CT or MRI potentially being more warranted.
Abstract
OBJECTIVE
To assess the perioperative analgesic effects of bilateral ultrasound (US)-guided quadratus lumborum block (QLB) using low-volume (LV) or high-volume (HV) bupivacaine, compared to a control group, in cats undergoing ovariectomy.
ANIMALS
48 healthy female cats.
METHODS
Cats were sedated with IM dexmedetomidine (5 µg/kg), ketamine (1 mg/kg), and methadone (0.2 mg/kg) followed by IV propofol induction and isoflurane maintenance. Cats were randomly assigned to 3 groups of 16 patients each: QLB-LV group (0.3 mL/kg/side), QLB-HV group (0.5 mL/kg/side), and control group (no QLB). Bilateral, in-plane, US-guided QLB was performed with lateral approach at the L2 transverse process with bupivacaine 0.2%. Physiological variables were recorded intraoperatively by a masked investigator. If intraoperative nociception occurred, fentanyl (1 µg/kg) was administered IV. Rescue postoperative analgesia (buprenorphine, 0.2 mg/kg) was administered in case of a Feline Grimace Scale score ≥ 4 after a 4-hour evaluation period.
RESULTS
In the control group, heart rate (HR) was higher than the QLB-LV group during the first ovarian manipulation (P < .001) and higher than the QLB-HV group during both ovarian manipulations (P < .001 and P = .006). The need for intraoperative rescue analgesia and postoperative pain scores were significantly higher in the QLB-LV (P = .005 and P = .047) and control (P < .001 and P < .001) groups compared to the QLB-HV group. Buprenorphine was administered once in the control group. No clinical signs of bupivacaine toxicity or QLB complications were observed.
CLINICAL RELEVANCE
Bilateral US-guided QLB-HV may effectively provide perioperative analgesia in feline patients undergoing ovariectomy.
Abstract
OBJECTIVE
To evaluate if opioid-induced behavioral effects, such as sedation, can be detected using a shuttle box experimental apparatus and whether thermal preference following noxious stimulation using mustard oil is reversed by morphine administration in fish.
METHODS
5 goldfish (Carassius auratus) underwent 2 randomized blinded experimental trials, with a crossover study design. First, opioid effects were tested in a shuttle box without painful stimulus. Fish were injected 5 days apart with butorphanol at 0.4 or 10 mg/kg, morphine at 5 or 10 mg/kg, or saline IM. After 30 minutes, each fish was placed in a shuttle box for 2 hours with a temperature gradient of 26 to 28 °C. Temperature preference, time spent immobile, and swimming velocity were assessed. The second trial consisted of cutaneous noxious stimulation using mustard oil immersion for 5 minutes followed by an assessment of thermal preference for 4 minutes in the shuttle box after either morphine at 10 mg/kg or saline IM injections. Linear mixed models were used to compare treatment groups.
RESULTS
Before noxious stimulation, a low dose of morphine caused sedation compared with control group and high-dose morphine and butorphanol treatments. Immersion in mustard oil caused fish to spend more time in the cold area in the control group. Morphine administration reversed this pattern.
CONCLUSIONS
The sedative and analgesic effects of opioids were detected through this model.
CLINICAL RELEVANCE
The shuttle box model could be used to assess the analgesic effects of other opioids in goldfish while reducing biases associated with the sedative and stimulatory effects of these drugs.
Abstract
OBJECTIVE
To explore client preferences for how value is communicated via written means and to assess the consistency of this preference with how veterinary clinic websites present this information for preventive care services.
METHODS
First, a questionnaire was developed to assess clients’ preference between 2 researcher-developed paragraphs recommending senior pet screening (one focused on the function of screening, the other on pet benefits of screening) and distributed from August 17 to November 2, 2023. Second, veterinary clinic websites were retrieved with a search engine using predefined search phrases related to 4 preventive care topics (flea and tick prevention, heartworm prevention, dental cleaning, and senior bloodwork). Each website was coded for the frequency of 4 codes related to how the value of the preventive care service was communicated (feature, function, pet benefit, or client benefit).
RESULTS
From the questionnaire, 58.0% (166/286) of participants preferred the benefit-focused communication. Those who saw the benefit-focused paragraph were more likely to indicate being “extremely likely” to discuss senior pet screening with a veterinarian. Of the 128 website pages coded, the mean text percentages for each code were 13.3% feature, 10.5% function, 6.4% pet benefit, and 1.0% client benefit.
CONCLUSIONS
Results suggest that opportunities exist to increase communication of the benefits of veterinary care on veterinary clinic websites, which may align more with clients’ preferences.
CLINICAL RELEVANCE
Through online communication, veterinary professionals may have an opportunity to increase client engagement with preventive care services by emphasizing the benefits of preventive care services in addition to the function.
Abstract
OBJECTIVE
Telehealth is the use of technology to deliver medical services. Potential uses among veterinarians include consulting with specialists about complicated cases, sending in electronic prescriptions, or meeting with clients to discuss patient health. Although the coronavirus disease 2019 pandemic posed many challenges to the veterinary profession, it accelerated the adoption of telehealth among veterinarians. As many of these changes took place quickly in response to the pandemic, many of those in practice did not receive much training or guidance; therefore, this study explores veterinary students’ perceptions regarding incorporating telehealth into the veterinary curriculum and the utilization of telehealth in the future.
METHODS
An email survey was sent to students at a veterinary school.
RESULTS
80 students provided answers to the 11-question survey. Nearly 80% reported that it is either “important” or “very important” to incorporate telehealth training into the veterinarian curriculum, whereas almost 90% indicated that they would benefit from more telemedicine training prior to graduation. Almost 75% of participants had legal and malpractice concerns, which may present a barrier to using the technology upon graduation.
CONCLUSIONS
This study suggests that veterinary schools should explore how to incorporate telehealth training into their curriculum, especially in regard to navigating the potential pitfalls that may be encountered when employing telehealth within the context of a veterinarian-client-patient relationship.
CLINICAL RELEVANCE
Telehealth is a valuable tool, and its use has become commonplace. Educational programs that emphasize telehealth will better equip future clinicians to manage the nuances of this modality in practice.
Abstract
OBJECTIVE
To describe the complications, surgical outcome, and prognosis associated with cystotomies in guinea pigs.
METHODS
A retrospective review of medical records of guinea pigs undergoing cystotomy for uroliths or urethroliths between 2010 and 2023.
RESULTS
25 guinea pigs were included in the study. Uroliths were confirmed on radiographs in all 25 cases, with 9 patients (36%) having at least 1 stone within the urethra. The cystotomy procedure was associated with an intraoperative complication rate of 24% and a short-term complication rate of 76%. Discomfort was the only presenting clinical sign significantly associated with survival, with a risk of dying prior to discharge that was a sixth of the risk of dying if a patient presented without signs of discomfort (risk ratio = 0.177). For patients with a stone within the urethra, the probability of death prior to discharge was 6 times that of patients with a stone within the bladder (P = .010; risk ratio = 5.966).
CONCLUSIONS
Cystotomies were associated with a mortality rate of 40% prior to discharge and 56% within the first month postoperatively. Further studies are needed to determine what specifically may lead to the high mortality rate as well as whether alternative minimally invasive procedures may be helpful in improving outcomes.
CLINICAL RELEVANCE
This study is the first to document risk factors, complications, and outcomes of a cohort of guinea pigs specifically undergoing cystotomy for urolithiasis. Given the high risk for complications and mortality, caution and owner preparation must be considered when a cystotomy is recommended for guinea pig patients.
Abstract
OBJECTIVE
To provide a video tutorial on the diagnostic ultrasound approach to the medial compartment of the canine shoulder and provide comparisons of normal and pathological images with corresponding MRI.
ANIMALS
Dogs undergoing diagnostic ultrasound of the medial shoulder.
METHODS
The medial shoulder was positioned in flexion with external rotation to allow transducer access, clipped, and scrubbed with dilute chlorhexidine. A 2- to 14-MHz linear array probe with a footprint of 50 mm (V8 ultrasound system; Samsung) was used to visualize the medial glenohumeral ligament (MGL), subscapularis, and coracobrachialis with coupling gel, confirmed by cadaveric ultrasound-guided dye injection and dissection. Ultrasound and corresponding MRI were then used to contrast normal anatomy to a live sedated dog with clinical subscapularis tendinopathy and MGL desmopathy. Proton density–weighted MRI sequences (1.5T Vantage Orian; Canon) using a flex coil were able to identify all 3 structures and corresponded to ultrasound findings for normal and pathological anatomy.
RESULTS
Diagnostic ultrasound identified normal and abnormal structures of the medial shoulder (coracobrachialis, subscapularis, and MGL). All imaging correlated well to MRI.
CLINICAL RELEVANCE
Medial compartment disease of the shoulder is a well-described cause of canine lameness, but diagnosis has traditionally relied on MRI or arthroscopy. Prior ultrasound approaches did not distinguish MGL components, failed to consistently identify normal or surgically transected ligaments, and have not been studied in vivo. Our approach is different and can play an important role in diagnosing medial compartment lesions, as it possesses greater anatomical visualization than arthroscopy and is noninvasive, accomplished with sedation, and relatively accessible and affordable.