Videos related to pain management

When I come across an online resource of veterinary information that I find interesting and think others would find useful, I like to share it here! This week, I came across some videos on Vimeo that demonstrate some important concepts in veterinary pain management. Here they are:

1. From Dr. Rick Wall: m. psoas major examination & treatment – As the veterinarian palpates the affected muscle belly (psoas major), you can clearly see from the dog’s reaction that the area is painful and needs treatment. Two patients are demonstrated in this video, a black dog and a boxer with short haircoat/lean figure. Dry-needling is also demonstrated, both with and without sedation. Be sure to watch the whole thing!

2. From Dr. Rick Wall: Feline Hyperesthesia Syndrome – This cat is extremely agitated and uncomfortable due to fleas. You can see by the convulsing that his response is far more intense than one would expect in a typical cat. The veterinarian gave him gabapentin, which modifies how the central nervous system perceives the pain signal, and you can see in the video that his agitation is less severe after receiving it.  [I had trouble embedding the video--click this link to see the video on vimeo.]

3. From Dr. Mark Hocking: Canine pelvic quadrant trigger point examination – Helpful narration explains what is being done and you can clearly see the dog’s response where he’s painful.

If you’re interested in learning more about trigger point examination and pain management in general, I highly recommend you join the IVAPM (International Veterinary Academy of Pain Management)–you will learn so much!!

Another resource I found recently (and it’s free!) is the Yahoo! group: triggerpointvet – you must be a veterinary professional to join, as membership/access is limited.

Do you know of other valuable pain management-related resources others might find helpful? Share them in comments below!

Journals: Clinican’s Brief

One of my favorite veterinary publications is the NAVC’s Clinician’s Brief. The March 2011 issue features a beautiful pictorial image of what you’re palpating when preparing to perform an epidural.

The issue thoroughly covers one of my most favorite topics in veterinary medicine: pain management. In addition to the well-illustrated and well-written how-to article on performing epidurals, there’s an article by IVAPM president, Dr. Mark Epstein, about news in the “pain management pipeline”.  I plan to write a separate post about the IVAPM as an invaluable resource, and why you should join if you are likely to ever encounter an animal in pain. We’ve been performing epidurals on all abdominal and orthopedic (pelvic limb) surgeries for at least the last year, perhaps the last two years. They are not technically difficult in the slightest, and I see no reason why general practitioners shouldn’t be performing them for things like: FHO, TTA (or other ACL surgery repair), patellar luxation repair, hind limb or tail amputation, cystotomy, abdominal exploratory, or c-sections. With this great article, hopefully more general practitioners will start doing these.

Dr. Mark Epstein’s article, “The Pain Management Pipeline: Pharmacologic Developments to Watch,” gives readers a glimpse of the future (and the future is now!) in terms of pain management for our patients. Several new, up-and-coming drugs are showing promise, although there’s still a lot more for us to learn. Dr. Epstein reviews some of these newer options, including: tapentadol, mexilitene, orphenadrine, long-acting opioids, and antiglial drugs. I know I’ll be following the IVAPM discussion boards closely to stay abreast of new information, as it becomes available.

This issue also included an interesting discussion on acupuncture, congenital luxation of the radial head in an English bulldog puppy (some very cool pictures of course!), and advice for clients with new puppies. And of course, I always love their “Capsules” section–brief reviews of veterinary articles that may be of interest to their readers but might not otherwise be seen by their readers (because we can’t subscribe to, let alone read, every single veterinary journal out there!). I learned that this “Capsules” concept is how the Clinician’s Brief originally began–and this was their 100th issue!

A supplemental issue of “Exceptional Veterinary Team,” the guide for problem-solving amongst hospital staff, was also included with the March 2011 issue of Clinician’s Brief. I admittedly didn’t read the whole thing, but I read the first article, “Dealing with a Medical Mistake,” by Erin Allen and Dr. Jane Shaw, with great interest. Can you imagine if you accidentally declawed the wrong cat? What would you do? I love its step-by-step guide in how to present bad news to a client in the best possible way, and there’s something reassuring about reading that, no matter how well you present the information, there may be negative consequences, but at least you were truthful, compassionate, and sincerely apologetic through it all. Malpractice suits most often result from a failure to take responsibility, apologize, and communicate openly. Dr. Jane Shaw is also one of the founders and primary educators for the Pfizer Frank Communication training I mentioned in an earlier post.

In case you missed it at the beginning of my post, here’s a link to the March 2011 issue of Clinician’s Brief:

• March 2011 issue of Clinician’s Brief

Did you read this issue? What was your favorite part?

Veterinary Dentistry

I am coming to realize–and this is up for debate–that the future of bread-and-butter income for small animal practice lies not with elective spays and neuters, but with dentistry. Unless a practice has a steady stream of new puppies from breeders or pet stores (and the significance of the latter will hopefully wane in the coming years due to heavy and unrelenting pressure on puppy mills), then most new puppies coming into a practice will already be spayed and neutered by shelters and low-cost spay/neuter clinics. Some general practices continue to offer orthopedic surgeries, such as ACL and patellar luxation repair and FHO’s, but increasingly orthopedic surgeries are referred to specialty practices that limit their services to these types of procedures (and other surgeries).

One area of service that still very much belongs in general practice is dentistry. Sure, there are veterinary dentistry specialists who perform root canals and other endodontic and orthodontic procedures not suitable for general practice, but the opportunity for small animal dentistry in general practice is huge. Our own hospital is a perfect example. It used to be that every week, we performed 10-12+ spays/neuters (and maybe 8 dental procedures) per week. After our relationship with a local pet store came to an end, those (already low) numbers dropped drastically. Now we do 1-4 spays/neuters per week, and 11-16 or so dental procedures per week. With each dental procedure averaging about $500, considerably more than our spays and neuters, dentistry is clearly an important component of a successful veterinary practice.

Considering how little dentistry I was taught in vet school (uh, none), I experienced a steep learning curve in the real world of veterinary dentistry. Fortunately, I had a great mentor (who now has her own dentistry practice), and I managed to do okay. But dentistry is one area where I always welcome new info (ok, you already know all of veterinary medicine is like that for me), which is why, without further adieu, I highly recommend the following veterinary dentistry resources:

• Veterinary Dentistry Today (make sure you subscribe to the email newsletter AND the blog!!)

• Dr. Brett Beckman’s Slideshare Presentations

• VIN (of course!): Dentistry Specialty Center

(VIN membership required to access this last one. Make sure to check out the “Dental Morph Videos by Dr. Bellows” under the “Slideshows, Images and Videos” section!)

Dr. Brett Beckman, the man behind the first two listed resources, has quite an impressive background (from his website: “Dr Beckman is immediate past president of the American Veterinary Dental Society. Dr Beckman is the sole veterinarian in the world who has completed extensive training to become regarded as a Fellow in the Academy of Veterinary Dentistry, a Diplomate in the American Veterinary Dental College and a Diplomate in the American Academy of Pain Management. He has published numerous peer-reviewed articles in the field of veterinary dentistry, oral surgery and pain management.  He has been honored as a candidate for the American Veterinary Medical Association/Delta Society national award for Veterinarian of the Year for 2004. In 2007 Dr. Beckman was honored as Alumnus of the Year by the Mississippi State University College of Veterinary Medicine.”) He clearly loves learning and teaching, as he does a phenomenal job of disseminating information about veterinary dentistry to the entire world. I think all TLV readers will get a lot out of his postings!

Veterinary Radiology

I love teaching and learning about veterinary medicine, so when I find another website with the same theme, you can bet I want to share it!

The website I want to share is VeterinaryRadiology.net. It’s run by Allison Zwingenberger DVM DACVR DECVDI (enough initials for ya?!) in Davis, CA.

You simply can’t ask for a better website in terms of learning about veterinary radiology. She generally posts a new case each week (pretty much all small animal), gives you some time to mull it over, then she posts the answers later in the week or the following week. The images range from standard survey films to CT and MRI images.

I love this opportunity to test my skills and learn, and I encourage all Learning Vet readers to join the discussion! Considering I missed a GI perforation on survey films of a ferret I radiographed earlier today (thank goodness we have a radiologist review our films, and extra-thank goodness she took a look at them today), I know I am always needing help interpreting films. Hmm, perhaps I should forward the films to Dr. Zwingenberger and see if she’d like to post them??

Has a radiologist’s review saved your butt? What was the case? Do share!