Block 5 Flashcards
What are the 4 categories of osteoarthritis management?
Nonpharmacological
Pharmacological
Complementary and alternative
Surgery
Within pharmacological, what are 3 methods?
Weight management
Activity modification / PT
Husbandry
What is primary OA?
Septic
What is secondary OA?
All other types
What is the goal of weight loss with OA?
Reduction in clinical signs
What 2 things play into a weight loss program for dogs with OA?
Client eduction (diet)
Exercise regime
What is a diet that can be used for OA?
Complete diet with Omega 3 FAs
What is a common reason for euthanasia with OA?
Cats urinating/deficating outside litterbox because it hurts to step in
What is important about exercise with OA?
Need to find happy medium. Too much will hurt joints
What are examples of husbandry changes for OA?
Bedding, stairs/ramps, litterbox adjustments
What is an example of symptom-modifying?
NSAIDs
What are 2 broad categories of drugs used for OA management?
symptom-modifying
structure-modifying
What are 3 types of joint injections for OA?
Cortcosteroids
Hyaluronic acid
Biocushions
What is the downside to corticosteroids?
Potential harmful on articular cartilage
What is the preferred corticosteroid?
Triamclinolone
What is the data on biocushions?
No objective data
What are the 2 broad categories of complementary?
Orthobiotics
Physical therapy/rehab
What are the 2 types of orthobiotics?
Platelet rich plasma (PRP)
Stem-cells
What type of stem cells are used to stem-cell therapy?
mesenchymal stem cells
Which of the orthobiotics has more objective efficacy?
PRP
What are 5 physical therapy/rehab methods?
Shock wave
Photobiomodulation (laser)
Acupuncture
Chiropractic
Ultrasound
What are the 4 surgeries that can be performed for OA?
Resurfacing
Joint replacement
Arthrodesis
Excision (FHO)
What is the best surgery for low motion joints?
Arthrodesis
How do you treat septic arthritis?
Antibiotics (ceflesporin)
How long do you treat a septic arthritis?
Minimum of 28 days
How often do you retap a septic joint?
Monthly until normal cytology is returned
What is the MOA of NSAIDs?
Inhibit COX (decrease prostaglandins)
What are 3 adverse effects of NSAIDs?
GI, hepatic, renal
What is the only NSAID labeled for cats?
Onsior
What is a non-NSAID option that acts similarly?
Grapiprant (galliprant)
What is the MOA of galliprant?
non-COX-inhibiting prostaglandin receptor antagonist
What receptor does grapiprant block?
EP4
What are adverse side effects of galliprant?
GI?
What is MOA of gabapentin?
mimics GABA
Inhibits Ca flow to halt release of excitatory neurotransmitters
What is MOA of tramadol?
weak mu-opioid action
Acts on noradrenergic and serotonergic systems
What are 5 side effects of tremadol?
Sedation
constipation
excitation
tremors
seizures
What is MOA of amantadine?
Antiviral
NMDA inhibitor
How long does amantadine take to become fully effective?
3-6 weeks
Amantadine is her 2nd choice to NSAIDs
What are teh 2 types of monoclonal antibody therapy?
Librela (dog) Solensia (cat)
What is the general MOA of monoclonal antibodies?
Decreased signal transduction in cell types involved in pain
What should be kept in mind with using librela in dogs?
Possible progression of OA, potentailly a progression of neurological disorders. Better for end stage dogs
What are 2 other supplements that may help with OA?
Glucosamine and chondroitin
What is the only supplement that has been proven to help with inflammation?
Omega 3
What needs to be considered when prescribing adequan?
Made from bovine trachea, beware of food allergies
What is a unique adverse side effect of cartrophen?
Coagulation issues (may improve subchondral and synovial membrane blood flow)
How do you treat an OCD lesion?
Arthroscopic or open open arthrotomy
What does the open arthrotomy entail?
Debride flap and shave to healthy bone
What are 3 medical treatments of tendiopathies?
PT/rehab
shockwave
PRP
What does post-op care look like for OCD lesion?
Pain management
Activity restriction for 8-8 weeks
What are 2 options for tendiopathies?
Medical treatment
Surgical treatment
What are 2 main surgeries for tendiopathies of bicep?
Tenotomy (cut tendon)
Tenodesis (put tendon back where it was)
What is surgical treatment of supraspinatus?
Tendonectomy
What is treatment for a traumatic LATERAL shoulder luxation?
External support in spica splint for 2-3 weeks if lateral
NO Velpeau
What is treatment for a traumatic MEDIAL shoulder luxation?
Velpeau sling
What disease is often caused by FCP?
Medial compartment disease
What is coronoid disease?
FCP - fragmented coronoid process
What does surgery of FCP look like?
Arthroscopic removal of “pebble in shoe”
What is goal of medial compartment disease?
Load-shifting procedure. Takes pressure off the medial joint compartment.
What is UAP?
Ununited anconeal process
What are 3 surgical options for UAP?
Lag-screw fixation
Ulnar osteotomy
Fragment removal
What surgical procedure of UAP is needed with a short ulna?
Ulna osteOtomy
What surgical procedure is needed for long ulnas or short radius (FCP)
Ulna osteCtomy
What is needed for ALL elbow dysplasia cases?
on-going medical management
What is an arthrodesis?
Permanently join 2 joints
What are 2 options for traumatic elbow luxation?
Closed reduction (spica splint)
Open reduction (transarticular fixator 6-8 weeks)
What is the treatment if carpal hyperextension at the antebrachiocarpal joint?
Pancarpal arthrodesis
What is the treatment of carpal hyperextension at the middle carpal joint?
Partial carpal arthrodesis (preserves antebrachiocarpal joint)
What are the 4 steps to an arthrodesis?
- Removal of all articular cartilage
- Functional anatomical alignment
- Bone graft
- Rigid fixation and compression
What might you see if a partial carpal arthrodesis over time?
Breakdown requiring pancarpal arthrodesis
What can you do for a mild collateral ligament injury?
Splint for 4 weeks
What is surgery for collateral ligament injury?
Ligament reconstruction
How do you treat acute flexor tendon laceration?
Splint in flexion for 6-8 weeks with passive ROM
What should you NOT do with carpal laxity syndrome?
Splint it
What are some managements of carpal laxity syndrome?
Appropriate diet and good footing
What is medical management of sesamoid disease?
Rest (4-6 weeks)
Pain management
Injections
What is surgical management of sesamoid disease?
Debridement
What is IMPA
Immune mediated polyarthropathy
What range of joints are most commonly affected by IMPA?
Distal joints
What is a less obvious sign of IMPA?
Fever of unknown origin with no obvious lameness or joint swelling yet
What does CBC of IMPA look like?
Non specific
How many stages of FUO (fever of unknown origin) diagnosis is there
3
What is the definitive diagnosis of IMPA?
Arthrocentesis (multiple joints)
What is the normal WBC count of joint fluid?
<3000
What percent is normally neutrophils?
<10%
What are the 4 subgroups of IMPA?
I - absence of defined association
II - association with infection
III - Associationed with GI disease
IV - associated with neoplasia
What is the most common subgroup for IMPA?
I
What is the most common cause of fever of unknown origin in dogs?
IMPA!!!
What is max amount of pred per day!!!???
2 mg/kg/day
What is treatment of IMPA?
Pred (try to keep under 1mg/kg/day
What are 4 potential side effects of pred?
Polyurea/polydipsia/polyphagia
Muscle atrophy
Insulin resistance
Be cautious with HCM cats
If you dont use pred, what is the other option that should be considered?
Cyclosporine
What is the best way to monitor signs of IMPA?
Rectal temps
What is another way to monitor IMPA from blood?
C reactive protein
Do cats get IMPA?
Yeah, rare
What are 3 times to apply a bandage?
Soft tissue injury
Bone and joint injury
Surgical wounds
What is the first layer of a bandage?
Primary layer
When do you skip the primary layer?
If no wound
What is the purpose of the secondary layer?
Absorb and hold exudate
Immobilize and support
Can you place the secondary layer too tight?
No, it will rip before it’s too tight
What is the tertiary layer?
Outer, protective layer
***What is the Robert Jones bandage used for?
Immobilization DISTAL to ELBOW or STIFLE
What is Robert Jones used for?
Short term immobilization
What bandage is most commonly used?
Modified Robert Jones
You can use Modified Robert Jones for post-op surgical wounds, orthopedic injuries, and open wounds
What 3 things does modified robert jones provide?
Compression
Mild immobilization
limb support
Which direction do you wrap with robert jones
Distal to proximal
Should you include toes in the badange?
Yes!
Where do you cast an animal/
Distal to elbow or stifle
What are the two types of fracturs where a cast is indicated?
Incomplete fractures
Fractures with intact adjacent bone
Should you ever cast proximal to stifle/elbow
no…
What type of fractures are contraindicated for cast?
Complete oblique, spiral, avulsion, or comminuted fractures
What breeds are not great for casting?
Toy breeds
How thick should the bandage under a cast be?
Not too thick, the closer the cast is, the more resistant to forces it can be
When should an Ehmer sling be used?
Post hip reduction/surgery
How do you apply the Ehmer sling?
Figure 8 patter (NEVER OVER TIBIA)
What is the splica splint used for?
Immbolization of scapula, shoulder, humerus, elobow
What must be ensured with the splica splint
Patient can still breath
What is the velpeau sling used for?
Prevent weight baring on thoracic limb
How are the joints oriented in velpeau sling/
Carpus, elbow, shoulder in flexed position
How often do bandages need changed?
Open wounds - daily
Closed incisions - 3-7 days
How often do casts/splints need changed?
10-14 days
Sorry… What 7 things must be monitored and warrant a bandage change?
Toe swelling
Toes cold
Irritation above bandage
slippage
wet bandage
Patient licking at bandage
change in limb usage
What are the 5 forces on a fracture?
Bending
Torsion
Tension
Compression
Shear
What is bending?
force in middle of bone
What is tension?
pull bone apart
What is torsion?
twisting of bone
What is compression?
Obvious (crushing at fracture site)
What is shear?
Compression on oblique fracture line
What type of force are splints and casts best at reducing?
Bending
(Bad at all others)
What is the rule of thumb for casts at joints?
Extend a joint above and a joint below fracture
What are IM pins?
Intramedullary pins
What is the only force that IM pins reduce?
Bending force
What are 2 modifications to increase IM pin strength?
Stack pinning (more than one pin)
Interlocking nails (put nails through pin)
What forces do external fixaters neutralize?
Compression
Torsion compression
What do lag screws provide?
Compression
How can you make a external fixater stronger?
“Transfixation pin cast”
Basically gets all forces
What do positional screws provide?
Maintain the position of the 2 fragments
What direction are lag screws?
Perpendicular to the fracture
When should you not use lag screws?
When there are multiple fragmented pieces
What is the cis and what is the trans side of the bone?
Cis is near, trans is far
What do lag screws provide?
Interfragmentary compression
What sides do the positional screw engage?
Both cis and trans
**PLATES ARE STRONGER IN TENSION THAN COMPRESSION
What is a dynamic compression plate?
Holes in plate have tapered edge that function as inclined plane
What are locking plates?
Screw heads lock into place
What do locking plates function as?
Internal fixators
What is a locking compression plate?
Can act as both
What is the weight baring axis of the pelvis?
Acetabulum
Ilium body
Sacroiliac joint
Sorry again… What are the 7 indications of surgical fixations of pelvis?
Fracture along the 3 weight baring parts of axis
Articular fracture (acetabulum)
>50% narrowing of pelvic canal
Neuro compromise (sciatic or femoral nerve)
Bilateral involvement
Multiple limb fractures
Intended use of animal
Repair of fracture becomes much harder after 5 days
How do you diangose SI fracture-luxation?
Should be able to follow one contiguous line along inside of ilium into sacrum
How do you do surgery on SI fracture-luxation?
Lag screw using largest possible
Other than a lag screw for SI fracture-luxation, what is another option?
Bolt - larger surgical approach
Do all SI fracture-luxations need to be surgically addressed?
No
Do ilial wing fractures need surgically addressed?
No
What is the lateral approach of an ilial body fracture called?
Gluteal rull up
What is most commonly used to surgically treat the ilial body fracture?
Bone plate
What are 3 options for acetabular fracture repair
Primary
Femoral head and neck ostectomy (FHO)
Conservative treatment
What is most common in acetabular fracture repair?
Plates
What are indications for FHO for acetabular repair?
Money
Highly comminuted
Heavy arthritis after surgery
What should you do if sciatic nerve is severed?
Consider amputation
Will ischial fractures normally repair on their own?
Yes
How do you repair a pubic fracture?
Commonly left untreated
What does conservative management look like?
Cage rest for 6-8 weeks
Controlled exercise on all 4 limbs
ANALGESIA
What is the indication for surgical repair in pelvis?
Along 3 weight baring points
What is special about toy breed radius and ulna fractures?
ALWAYS surgical!
Why are they always surgical?
Blood supply to distal radius compromised compared to large breed dogs
What is a good rule about fixation of bone plates?
6 proximally and distally
What is goal of compression plating?
Compression at fracture site to assure contact of bone fragments
Primary bone healing
What type of fracture is necessary for compression plating?
Transverse fractures
What is the goal of a neutralization plate?
Neutralize disruptive forces at the fracture site
Where do you find neutralization plates?
Where you find lag screws or wires
What is the goal of buttress plating?
Bear entire functional load (no load sharing)
Indicated in non-reconstructable long bone fractures, lots of comminuted zones.
Focus on preserving blood flow
Prolonged casting causes DJD
What is the timeline for surgery of articular fracture repair?
1-2 days
What makes the size of a bone screw?
Diameter of screw with threads
How do you put in a lag screw for 3.5mm?
You drill a 3.5mm hole in the cis side then a 2.5mm hole on trans side for it to pull together
What are the 4 steps to a lag screw?
- Drill
- Measure
- Tap
- Screw
Is inside-out or outside-in drilling more accurate? (aka medial-lateral)
Inside-out
What 2 things do you want to see alignment of before reducing medial condyle?
Anconeal process and semilunar notch
K wire is also used to help reduce chance of migrating distally or creating seroma
What approach should you take to the elbow?
Caudolateral
What are the 2 things used to repair the condyle?
Transcondylar lag screw and anti-rotational K-wire
What is a stifle derangement?
Disruption of multiple ligaments within the stifle
What is often affected within stifle derangements?
Menisci
What is more common, medial collateral or lateral collateral?
Medial collateral
What is the medial repair of collateral stifle derangement?
Locking loop suture
What is done before repair of stifle deraingements?
Debridement of torn meniscii
What is the lateral repair of collateral stifle derangement?
Prosthetic augmentation
What is proximal intertarsal luxation?
Disruption of plantar ligaments
How do you treat proximal intertarsal luxation?
Partial tarsal arthrodesis
What is recovery for partial tarsal arthrodesis?
Lateral splint for 2 weeks
What is recovery for superficial digital flexor tendon luxation?
Lateral splint 3-4 weeks
In hoof trimming, do you take more off the toe or the heal?
Toe!
How many inches should it be from coronary band to the toe tip?
3-4 inches
What leg is usually lame in the cow?
The hind limbs
What claw is usually lame in the hind limbs of a cow?
Lateral claw
How should the block be aligned on a cow claw?
The toe should be aligned with the front edge of the block
What is the treatment protocol for laminitis?
Analgesia
Cold water therapy
Corrective trimming
What must be done with a sole abscess to progress healing?
Remove all dead tissue down to healthy tissue
What is important to note about corkscrew claws?
Possible genetic component
What is treatment for corkscrew claw?
Corrective trimming
Normal anatomy is never achieved with corkscrew claws
What are teh 3 point blocks of corns?
Axially
Medially
Laterally
What is interdigital hyperplasia also known as?
Corn
Do you need to remove corns?
Not unless causing lameness
How to treat interdigital hyperplasia?
Wedge shaped incision
Peel working dorsal to palmar
Wire toes together
Place bandage
What is the technical term for footrot?
interdigital dermatitis
What is treatment of interdigital dermatitis?
Debride with betadine
Topical antibiotics
What is footrot called when it gets into the deeper layers?
Interdigital phlegmon
How is treatment different for interdigital phlegmon?
Need systemic antibiotics and introduce food bath
Give 4 antibiotics that are labeled for footrot
Excenel (ceftiofur)
Naxcel
Excede
LA 200 (oxytet)
What are 2 drugs that are labeled for beef cattle/non-lactating cattle
Nuflor
Draxxin
What is the medical name for hairy heel wart?
Digital dermatitis
What is treatment for digital dermatitis?
Tetracycline powder/paste
Systemic oxytet (LA 200)
Need footbaths and good biosecurity
What are likely involved in hairy heel wart cases?
Spirochetes
What is the block of the cattle foot?
Bier block
How does the bier block work?
Tourniquet and enter the dorsal common digital vein right on midlin
What is the salvage surgery for the digit?
Digit amputation
What si the restoration surgery for the digit?
Facilitated ankylosis
What is important to consider when amputating a digit?
Try not to have articular exposure
What is the disadvantage of digit amputation?
Usually reduction of production life
How do you approach for facilitated ankylosis/
Follow the draining tract
What should you expect up to 2 months after facilitated ankylosis?
Lameness for a while (need block for 2 months)
What is something really important to booster when you have a horse with a foot abscess?
Booster tetanus!
Other than tetanus, what is the treatment for a foot abscess?
Establish drainage
Soak foot to draw out fluid
Foot bandage
NSAIDs
What is a way to protect the sole other than bandaging?
A hospital plate (the metal plate thing)
Where does a hoof abscess usually come out?
At the coronary band
What are teh 3 potential causes of laminitis?
Endocrine laminitis (Cushings or equine metabolic)
Sepsis/endotoxemia
Supporting limb laminitis
Sorry… Give 6 treatments of laminitis
Address underlying cause
Remove standard shoe soon in treatment
Pain management
Give acepromazine for better digital blood flow
Ice the hoof
Put on therapeutic shoes
What is a crazy treatment for chronic laminitis?
Deep digital flexor tenotomy
What is type 1 of distal phalanx fracture?
Non articular, palmar process
What is type 2 of distal phalanx fracture?
Articular, palmar process
What is type 3 of distal phalanx fracture?
Sagittal, articular (down the middle)
What is type 4 of distal phalanx fracture?
Extensor process
What is type 5 of distal phalanx fracture?
Comminuted
What is treatment of P3 fractures?
Lag screw for II and III
Long term stall rest
Bar shoe
Where does bone growth occur?
Metaphyseal growth plate
What is varus?
Splayed legs (Knees out)
What is valgus?
“Knocking knees”
What does HPTE stand for?
Hemicircumferential periosteal transection and elevation
What does HPTE do?
Slows down growth on one limb to straighten deformity (must be done on growing animal)
How would you treat carpal valgus deformity?
Segmental distal ulnar ostectomy (remove bone so it grows out and straightens)
What does PCDUGP stand for?
Premature closure of distal ulnar growth plate
What is the #1 deformity in dogs?
PCDUGP
What does the dynamic proximal ulnar osteotomy not address?
Angular or torsional deformity
What is normal angle for femur?
4-6 degrees
What is the threshold for the femur?
15-20 degrees
How do you surgically correct femur angle?
TPLO jig
What is the C in LBCWO?
Closing
What is the O in LBOWO?
Opening
These are used for opening vs closing wedges (honestly can’t really tell the difference in pictures) Closing seems to be on the medial and opening seems to be on the lateral side tho!!
Is an opening or closing needed for varus?
Opening
Is an opening or closing needed for valgus?
Closing
What is distraction osteogenesis?
Mechanical induction of new bone formation between osteotomy surfaces that are gradually pulled apart
How often does it need to be pulled apart?
2x a day
What is type 1 salter harris?
Through physis
What is type 2 salter harris?
Through metaphysis
What is type 3 salter harris?
Through epiphysis
What is type 4 salter harris?
Through both
What is type 5 salter harris?
Compression of physis
What is something important to consider when repairing a Salter Harris fracture?
Avoid bridging physis with pins
What type of pins do you want across physis if needed?
Smooth fixation pins
What needs to occur during Salter Harris fractures?
Continuous movement
What do you need to be aware of with plates in growing patients?
May need to remove plate to allow for contiued growing
What is a synonym for DJD?
OA
What are teh 3 primary stabilizers of hip?
Ligament of head of femur
Joint capsule
Dorsal acetabular rim
What is the most common luxation?
Hip! 90% of luxations
What is the most common direction that the hip luxates?
Craniodorsal
Functional loss of 2 or more of these = luxation
What causes craniodorsal (and medial) to be so common?
Pull of the gluteal muscles
What is the characteristic stance that luxated hips have?
External rotation and adduction
What are the palpable landmarks for orthopedic exam?
Tuber ischia
Greater trochanter
Craniodorsal ilium
When should a closed reduction not be attempted?
Signs of severe hip dysplasia
Articular fractures
Avascular necrosis of femoral head
Chronic presentation
What does a closed reduction require
General anesthesia to relax muscles
How do you perform a closed reduction?
Lateral recumbancy
Externally rotate
Pull slightly caudally
Gentle internal rotation
What do you do immediately after you believe the hip is reduced?
Feel for landmarks
After you feel landmarks, what should you do?
Push on greater trochanter in medial direction for 5 min
Put limb through full range of movements to displace blood clots
Retake rads
For a ventral luxation, which direction do you pull to reduce it?
Distal traction
Abduction of limb
What is the point of an Ehmer sling after hip luxation?
Maximize acetabular coverage of femoral head
What is a way to help with ventral luxations after you send them home/
Hobbles (like cows)
What are 4 indications of open reduction?
Chronic luxation
Recurrent luxations after closed reduction
Severe instability of collateral ligaments
Bilateral coxofemoral luxations
What 2 things should you primarily base your decision on for open stabilization?
Presence of fractures, hip dysplasia or OA
Extent of cartilage injury
What is the most common approach for open stabilization?
Toggle-rod stabilization
What is toggle-rod stabilization?
Replace ligament of head of femur with a synthetic prosthesis
It looks like you drill through femur head and acetabulum to put a string through to act as teh ligament
If toggle rod does not work, what is natural next option?
THR (total hip) or FHO (femoral head)
How do you perform closed reduction of elbow?
Medial pressure on olecranon
Then medial pressure on radial head
***Antebrachium is pronation with ADDuction with concurrent ABDuction of elbow
Should watch a video on this
What splint is used after elbow reduction?
Spica splint for 2-3 weeks
What approach do you use for open reduction of elbow?
Lateral approach
What type of dogs are most likely to have congenital hip dysplasia?
Larger dogs >5months
What is a presentation of dogs with hip dysplasia?
Bunny hopping up stairs
What is the most common way to treat congenital hip dysplasia?
Medical management (weight management, coequine, NSAID)
What is the most common exasterbator of hip dysplasia?
Obesity
What is the only surgical option for immature dogs that has been tested?
Triple / double pelvic osteotomy
In an abduction/relocation test, what are the steps and what should you feel?
Abduction of the hips until you feel a click or a pop and then adduction
**What is the angle of subluxation?
Angle between the femur and the median plane at which teh femoral head subluxated with adduction. (Angle where is pops out)
**What is the angle of reduction?
It is the angle between the femur and the median plane at which teh femoral head reduces from abduction. “Angle at which it pops in”
What does a loud vs quiet pop indicate during reduction?
Loud = more remodeling
Quiet = little remodeling
What angles of reduction and subluxation make it a good candidate for triple pelvic osteotomy
Reduction <30
Subluxation <10
What is the TPO dilemma?
Earliest surgery is the best but at the same time, waiting longer can also allow for spontaneous resolution
What is Legg Calve Perthes disease?
Collapsing “sink hole” of femoral head
Is LCP usually unilateral or bilateral?
Unilateral
What position can you usally best see LCP in?
Frog legged view
What is chronic femoral capital physeal fracture related to?
Early neuter and obesity in male cats
What is most common treatment of chronic femoral capital physeal fracture?
FHO
(Apple core disease)
Where do septic (infectious) joints usually occur?
Proximal joints in large breed dogs
What must be preserved in an FHO?
The lesser trochanter for insertion of ileal soleus muscle
How much of the neck do you need to remove for the best outcome?
Remove as much of the next as possible without the lesser trochanter
What is the saying for neoplasia in the limbs?
Away from the elbow, toward the knee
Are sole abscesses usually bilateral or unilateral?
Unilateral
Is navicular disease usually bilateral or unilateral?
Bilateral
Are P3 fractures usually bilateral or unilateral?
Unilateral
Is laminitis usually bilateral or unilateral?
Bilateral
Are puncture wounds usually bilateral or unilateral?
Unilateral
What is solar penetrating wound also called?
Street nail
What are 3 things to consider with “street nail”
Coffin joint
Digital flexor
Navicular bursa
What is first thing to approach a puncture wound to foot?
Evaluation and determine synovial involvement
What is treatment of traumatic puncture wounds in hoof?
Debride + Systemic and local antimicrobials
How long is controlled exercise for tendons?
6 months
How long is controlled exercise for ligaments?
8 months
What are top 3 treatments for tendon and ligament injuries?
Minimize inflammation (bandage / cold hose)
NSAIDs
Correct trimming
Strict stall rest for 1-2 weeks!!
What are 3 biologics for modulating tendon healing?
- PRP
- Bone marrow aspirate concentrate
- Cell based therapies
What is navicular syndrome?
Kind of a catch all term for palmar heel pain with or without bony involvement
Bone marrow aspirate was shown to significantly decrease reinjury rate in racehorses
What is true navicular syndrome?
Bone involvement
How do you have to diagnose navicular syndrome?
MRI is needed
What are 3 oral NSAIDs for horses?
Bute, Equioxx, banamine
Where can you put intrasynovial injections in hooves
Coffin joint
Navicular bursa
3 treatments for navicular disease?
Corrective farriery
NSAIDs
Intra-synovial corticosteroids
What is usually wanted in corrective farriery?
Shorten toe and grow heel
What disease do racehorses usually get?
SDFT
What is the most important tissue to protect?
SKIN!
Why is skin the most important?
Reduced chance of infection with intact skin whne planning to repair fracture
What are 4 REALLY important principles of fracture immobilization?
Immobilize joints proximal and distal to the injury
Never end a cast in the mid-diaphysis of a long bone
Never end a cast near the fracture line to be stabilized
When possible, include the foot in the coaptation
Is more padding good?
No, more padding will decrease stabilization!
Where do you apply a splint?
OVER bandage material
Does it matter what you use as a splint construct?
Nope
What is region 1 of horse splinting?
Distal limb
What is a good splint to use in region 1?
Kimzey leg saver
What is the downside to the Kimzey leg saver splint?
No side to side (medial lateral) stability
Do you need emergency coaptation for P3 fractures?
No
What is included in type 2 fracture?
Metacarpal/tarsakl
What bandages are best in #2 region?
Robert Jones for metacarpal
Modified Robert Jones for carpal
What is region 3 of coaptation?
Forearm and crus
What is the further breakdown of 3?
3a - radius and tibia
3b - ulna
What stability issue do you run into with the ulna/3b?
Passive stay apparatus
What region cannot be stabilized with external coaptation?
Proximal limb (4)
How should you treat an extensor tendon laceration?
Robert jones bandage
How should you treat a flexor tendon laceration?
Like a region 1 fracture
Dorsal or plantar splint
What structures are included in region 4?
Humerus
Scapula
Femur
Pelvis
How should you treat a collateral ligament laceration?
Medial to lateral support as well as dorsal/palmar
Which direction should you load a horse with a hindlimb fracture?
Forward
What is the goal of adding a sedative/opioid to seizure control?
Reduce excitability and additional injury
Which direction should you load a horse with a forelimb fracture?
Backwards
What is LCC in equine brain injury?
L - localization
C- Characteristic
C - Cause
What are the drugs used for longer term seizure control?
Barbiturates - phenobarbital
Levetiracetam (for foals)
What 4 drugs will help control edema?
Hypertonic saline
Mannitol
Furosemide
NSAIDs
What are the drugs used for immediate seizure control?
Benzos
Diazepam
Midazolam
What are some sedatives that can be used to help control seizures?
Xylazine
Detomadine
Butorphanol
What is the pathology of THO?
Articulation between stylohyoid and temporal bone causing facial and vestibular nerve dysfunction
What are 2 additional drug types that can be added?
Antioxidants (Vit C, Vit E, Selenium, DMSO)
Antithrombotic (heparin, aminocaproic acid)
What is initial treatment of THO?
Reduce inflammation (flunixin, DMSO, dex)
What is needed to help cure THO?
Surgery - ceratohyoidectomy
What is THO>
Temporohyoid osteoarthoropathy
What s treatment of cerebellar abiotrophy?
None!
What needs to be done about the eyes in THO?
Suture them shut - tarsorrhyaphy (even when no ulcers are present)
What is cerebellar abiotrophy caused from?
Perkinje cells disappear (genetic)
What breed gets idiopathic epilepsy the most?
Egyptian Arabian Foals
What is NMS?
Neonatal maladjustment syndrome
What causes sedative state of NMS?
High progesterone
What is treatment of NMS?
Hydration
Energy
Protection
Where does EPM come from?
Raccoons and possums
What is parasite of EPM?
Sarcocystic neurona
How long do you treat the EPM?
30-60 days
What other medical support for EPM should you provide on top of primary?
Vit E + Se and DMSO
What does a lesion at T3 - L2 cause?
Thoracic - Normal
Pelvic - UMN
What are the only 2 FDA approved EPM treatments?
Ponazuril
Diclazuril
What are 3 possible treatments for EPM?
Ponazuril
Diclazuril
Toltrazuril
(ReBalance)
What causes wobblers?
Genetics
Fast growing (excessive feeding)
Low dietary copper and zinc
What does a lesion at C6-T2 cause?
Thoracic - LMN
Pelvic - UMN
What is cervicovertebral malformation also known as?
Wobblers
What does a lesion at L3-S2 cause
Thoracic - Normal
Pelvic - LMN
What is the intermittent version of wobblers called?
Cervicovertebral instability
What is the continuous compression of wobblers called?
Cervicovertebral stenotic myelopathy
What does a lesion at C1-C5 cause?
Thoracic - UMN
Pelvic - UMN
What group of wobblers is surgery mostly indicated for?
Dynamic compression group (CVI)
What does a lesion of LMN cause?
Decreased neuron activity
What does a lesion of UMN cause?
Increased neuronal activity
What is a long term treatment of wobblers?
Cervical articular facet injection with glucocorticoids
METHYLPREDINISOLONE
What is treatment of acute wobblers?
NSAIDs
medical support
antioxidants (Vit E)
How much does surgery reduce ataxia by?
1 grade - not a full cure
What is conservative management in a foal?
Decrease calorie intake
Give shitty hay
No grain
Low success tho
How do you treat edema associated with CNS trauma?
Diuretics, hypertonic solutions
Where are UMN signs found in relation to the lesion?
Distal
How do you treat oxidative injury?
Antioxidants like Vitamin E and C
What are the 2 conditions associated with vitamin E deficiency?
equine motor neuron disease (EMND)
equine degenerative myelopathy (EDM)
What are the 2 parasites that cause EPM?
Sarcocystis neurona (95%)
Neospora hughesi (5%)
What can you do for EHM on top of palliative care?
Antivirals - valacylovir
Reduce inflammation - NSAIDs DMSO
Reduce coagulation/thrombosis - heparin
Apply biosecurity
What is the neurologic version of EHV-1 called?
EHM - equine herpesvirus myelopathy
What disease is associated with white matter?
Equine degenerative myelopathy
What disease is associated with grey matter?
equine motor neuron disease
What disease do you see urinary incontinence with?
EHM
How do you treat equine motor neuron disease?
Vitamin E
What does equine motor neuron disease cause?
weakness, no ataxia
What does equine degenerative myelopathy?
ataxia, no muscle atrophy
How do you treat EDM?
Just vitamin E
When should you not use acepromazine as sedative?
In hemodynamically compromised patients - vasodilator
Why do you need to be judiscious with pain management in equine trauma cases?
Dont want to encourage weight baring on unstable/broken limb
When in doubt, how should you treat a horse injury?
Like a fracture
What is indicated immediately for open fractures?
Antibiotics
What should be a concern when there is damage or stretching to a neurovascular bundle?
Thrombosis
How do you counteract thrombus formation?
Anti-thromotic agents
What type of antibiotics should be used?
Broad spectrum
What should be given with wound management?
Tetanus toxoid
Do not anesthetize patients in the field to take radiographs if you plan to take them in anyway
What is confinement time for conservative management of an incomplete or nondispalced fracture?
3-4 months
What is the longer bone of the elbox?
Ulna
What type of stabilzation is needed for a P3 fracture?
Not needed, within hoof is good enough
How do you treat flexor tendon ruptures?
Treat like region 1 fractures
Other than thiamin, what else needs to be acchomplished in polio?
Reduce cerebral edema
What is the initial treatment for polioencephalomalacia?
Thiamin
What drugs do you use to reduce cerebral edema?
Dex
Mannitol
Furosemide
What is an additional concern in polio?
Seizure control
What is a non-listeria cause of polio?
Lead poisoning
What are the 2 treatments of listeria?
Antibiotics
Anti-inflammatory
What antibiotics do you give for listeria?
Penecillin
Oxytet
What anti-inflammatories can be given for listeria?
Banamine
Dex
What is a sequela of listeria that should be considered?
Hard time closing eyes
How do you treat meningeal worm?
Anthelmintic
Anti-inflammatory
What anthelmintic do you use to treat meningeal worm?
Fenbendazole
What anti-inflammatory is food for meningeal worm?
Dex
Banamine
What are the 2 other animal hosts of meningeal worm?
Deer and slugs
What is type I IVDD?
Extrusion
Is a shotgun therapy ok for CNS diseases of farm animals?
Yes! - antibiotics, anti-inflammatories, thiamine, anthelmintics
What is type II IVDD?
Protrusion
What is extrusion?
Acute
What is protrusion?
Chronic
For extrusion, how can ambulatory dogs be managed?
Conservative management (NSAIDs)
If paraplegic with disc extrusion, what is required?
Surgery ASAP
What is the best diagnostic for IVDD?
MRI
Are corticosteroids useful in acute IVDD?
No
What is the conservative treatment for IVDE?
STRICT CONFINEMENT (at least 4 weeks)
NSAIDs
Have steroids been shown to help with IVDE?
No but help with pain
What percent of patients that undergo surgery recover?
95% (with intact nociception)
What is known as Type III IVDD?
Acute non-compressive nucleus pulposus extrusion (ANNPE)
What causes ANNPE?
Trauma or intense exercise
Basically a disc hits the spinal cord and bruises it
Is ANNPE contusive or compressive?
CONTUSIVE (bruise)
What is sometimes called type IV IVDD?
Hydrated nucleus pulposus extrusion (HNPE)
What is treatment of ANNPE?
Time and physical therapy (NOT SURGICAL)
What is HNPE?
acute disc causing a fluid bubble
How do you treat HNPE?
Usually medically, waiting
What is FCEM?
Fibrocartilaginous embolic myelopathy
What happens in FCEM?
Spinal cord infarct caused by a fragment of fibrocartilaginouis material
What is progression of FCEM?
Acute and non progressive
Is FCEM symetric or asymetric?
STRONGLY asymmetric
Do FCEM patients have pain?
NO!!
What is treatment of FCEM patients?
Supportive care, no steroids!
What is an important first step in spinal trauma patient?
Fluid therapy
Do you use steroids for spinal trauma?
No… doesnt help
With spinal trauma, what do you want to give?
NSAIDs to reduce inflammation
What is cage confinement of spinal trauma?
4-6 weeks
Is external splinting an option for spinal trauma?
Yes
What is the prognosis of spinal trauma patients with deep pain?
90% walk again with physical therapy (recovery can be long)
What is prognosis without deep pain?
80-90% do not walk again! :(
Is cauda equina (degenerative LS stenosis) technically a spinal disease?
No
What is paraparesis?
Loss of motor function in the pelvic limbs
Who gets IVDD II (IVDP) most often?
Large breed dogs
Are IVDP patients usually ambulatory?
Yes
What is conservative treatment for IVDP?
Anti inflammatories - steroids are actually very helpful here!
**What is contra-indicated with IVDP?
Confinement!!
Is surgical treatment for IVDP usually done?
No
What are differences between treatment of IVDE vs IVDP?
IVDE: Acute, surgery ASAP, no steroids, confinement
IVDP: Chronic no surgery, steroids good, no confinement
What is degenerative myelopathy?
Slow progressive disease causing non-painful ataxia
What is the best treatment or degenerative myelopathy (DM)?
Daily exercise
So far I can only think of one disease where steroids are helpful, IVDP. Maybe one other?
Are steroids helpful for degenerative myelopathy?
No!
What is DLS?
Degenerative lumbosacral stenosis
What is DLS also known as?
Cauda equina
Where is the protrusion of degenerative lumbosacaral stenosis?
L7-S1
Does DLS cause paraplegia?
No
Does DLS cause ataxia?
No
Does DLS cause paraparesis?
Yes
Can DLS be unilateral?
Usually is
What is treatment of DLS?
Conservative: Exercise restricition (4-8weeks)
NSAIDs or steroids!
If conservative treatment for DLS doesnt work, what is next?
Epidural steroids - methylpred acetate
If epidural steroids for DLS doesnt work, whats next?
Surgical treatment
What is treatment for spinal tumor?
Varies with type
What is CSM?
Cervical spondylomyelopathy
What is treatment for CSM?
Exercise restriction
Body harness instead
Steroids!
Physical therapy
What is most common surgery for CSM?
Ventral slot
What is nociceptive pain?
Damage to non-neural tissue (discospongylitis)
What are the 3 main structures that cause spinal pain?
Meninges
Nerve roots
Vertebra
Where is discospondylitis most common?
Lumbosacral
What is neuropathic pain?
Lesion of disease of the nervous system
Where is discospondylitis 2nd most common?
Thoracic
What should you also test for when you are considering discospondylitis?
Brucellosis
Why is discospondylitis so painful?
Infection of many different things (bone, muscle, meninges, nerve roots)
How is disco treated?
With antibiotics
How should you start treatment of disco?
Start with broad spectrum - Clavamox or cephalosporine
How long do you need to treat with antibiotics?
2-3 months at least
Is discospondylitis and spondylosis the same?
NO! -itis infection
What is SRMA?
Steroid responsive meningitis-arteritis
What does SRMA do?
Immune-mediated response against meninges and arteries
What disease is the BBB disease?
SRMA
When do dogs usually get SRMA?
6m-2years
Do SRMA patients have pain/? Fever?
Yes yes
How do you get definitive diagnosis of BBB?
Spinal tap
What is treatment for SRMA?
Prednisone
What is CLM-SM
Chiari-like malformation and syringomyelia
What is the CLM-SM?
Overcrowding in the skull pushing the brain into the spinal space
Who gets CLM-SM?
Cavalier King Charles
What is allodynia?
Pain from stimulus not normally painful
Do whip worms or barber pole worms cause more diarrhea?
Whip because they are further along in GI tract
What can you give CLM-SM in severe cases to reduce CSF production?
Omeprazole
What age patients get coccidia?
Younger patients
Where is myelomalacia found mostly?
L4-L5
When do progressive signs begin for myelomalacia?
at 24-48 hours
What happens to produce a negative outcome for a myelomalacia patient?
Change in the cutoff of the cutaneous trunci reflex (cranial migration)
“If they dont walk 3 months after IVDP surgery, they likely will never walk again”
What is the outside part of a disc?
Anulus pulposus
What is the center area of a disc?
Nucleus pulposus
What is a good muscle relaxant for cervical IVDE?
Diazaepam
What is treatment for cervical IVDE?
Bascically the same as normal IVDE
As a GP with IVDE, what is our goal?
Refer as quickly as possible
What is seen on MRI with FCE?
A bright spot at the lesion
Who most commonly suffers from FCE?
Large breed dogs
What is needed with FCE?
Just time to recover. Slow but usually works
Is FCE painful?
No!
Is FCE surgical?
Not usually
***Is FCE asymmetic
YES!
***Is ANNPE Bilateral??
NO! Asymmetric!
What type of edema do steroids help? Not help?
Help: Chronic vasogenic edema
Not help: Acute cytotoxic edema
What is the only way that CLM-SM is seen?
MRI
Where does the spinal cord end in dogs?
L5
Is there surgery for CLM-SM?
No
“What is the best treatment”
Correct diagnosis
What is meningitis?
Inflammation of the minengial layer
What is myelitis?
Inflammation fo the spinal cord parenchyma
What is encephalitis?
Inflammation of the brain parenchyma
What is leuko-
white
What is polio-
grey
What is -malacia?
Softening
What does meningoencephalomyelitis mean?
Inflammation of the meninges, brain, and spinal cord
Is infectious meningoecephalomyelitis more common in cats or dogs?
Cats
What does MUO mean?
Meningoencephalomyelitis of unknown origin
Does MUO fall under infectious or non-infectious?
Non-infectious
What are the 3 disease of MUO?
GME = Granulomatous meningoencephalomyelitis
NLE = Necrotizing leukoencephalitis
NME = Necrotizing meningoencephalitis
(NLE + NME = NE (Necrotizing encephalitis))
What are 4 diagnostics to run for inflammatory CNS disease?
Blood work
MRI
CSF tap
Infectious disease testing
How do you differentiate between NLE, NME, and GME?
Need histo
What 2 things are often elevated in CSF analysis for inflammatory disease?
Total nucleated cell count (TNCC)
Protein
Are infectious organisms seen on CSF?
Rarely
What type of cells are seen for fungal inflammatory disesaese?
Eosinophilic
What type of cells are seen for bacteral or viral inflammatory diseases?
Neutrophils
Does a nomral spinal tap rule out inflammatory cause?
NO!
What type of meningoencephalitis is most common in dogs?
MUO
What infectious forms are common in cats?
Dry FIP
FIV
FeLV
What are MUO presumed to be?
Immune-mediated
What breeds most often get MUO?
Small breeds (young or old)
What is needed for histo to determine MUO?
Brain biopsy or post-mortem exam
For infectious disease, what are some diagnostics to run?
Antibody titers/culture
Serume
CSF
Urine
Should you stop treatment with antibitoics when the animal is feeling better?
No!
What type of antibiotic must be given for cranial infectious etiologies?
Antibiotics that can cross the blood brain barrier
What does the ideal antibiotic have for infectious causes?
Bactericidal!!! and Cross BBB
MOST BE BACTERIACIDAL NOT STATE!
When should you recheck CSF?
2 weeks beyond resolution of signs
What is first choice of antibiotics?
Ampicillin/amoxicillin
What should be given in addition to antibiotics for CNS bacterial infections?
Steroids (5 day course)
What is the ideal drug for fungal diseases?
Fluconazole
When does ampicillin/amoxicillin cross BBB?
When inflamed
How long do antifungals need to be given?
Months to years
What needs to be tested after treatment of CNS fungal?
CSF AND fungal titers
What antifungal is used for aspergillus?
Voriconazole
What is #1 fungal to enter the CNS?
Crytococcus
What is the #1 viral CNS infection for dogs? cats?
Dogs - distemper
Cats - FIP
What is #1 CNS protozoal infection?
dog - toxoplasma and neospora
cat - toxoplasma
What is first choice against protozoal infections?
Clindamycin?
What 2 things are good for infectious causes of CNS disease?
Anti-whatever
Steroid for a short corse (5-10days)
How long to treat for protozoal infection?
At least 4 weeks
How to treat for tick borne CNS infection?
Rare
Doxycycline
What are 2 general principles for CNS treatment?
Early and aggressive and long term (relapse common)
What is teh treatment for immune-mediated CNS disease?
Steroids
How much more potent is dexamethasone than pred?
7-10x stronger
How do you start steroid dosing?
Start with anti-inflammatory dosing then progress to immune suppression dosing once infectious etiology is ruled out
How do you dose steroids?
Controlled taper - 20-30% every 3-4 weeks
What are teh 3 types of edema?
Vasogenic
Cytotoxic
Interstitial
What is vasogenic edema?
Extravascular accumulation of fluids - usually white matter - due to increased vascular permeability
When is vasogenic edema usually encountered?
With tumors
What is cytotoxic exema?
Cellular swelling due to intracranial accumulation of sodium and water
When is cytotoxic edema usually encountered?
Seizures
What is intersitial edema caused by?
Abnormal CSF flow
What 4 things contribute to ICP?
Brain
CSF
Blood
Added stuff (tumors and shit)
What is CPP
Cerebral perfusion pressure?\
What is the equation for CPP?
Mean arterial pressure (MAP) - ICP
What is CBF?
Cerebral blood flow
What is cerebral blood flow?
Volum eof blood that flows through the breain
How is increased ICP related to CBF?
Increased if vasodilaiton occurs, increasing CBV (cerebral blood volume)
What does the autoregulation of the brain do?
Homeostatic mechanism that limits cerebral hypoperfusion in systemic hypotension and edema in hypertension
Basically an increase in one must have an equal decrease in another
What is the range in which autoregulation is able to work within?
50mmHg - 150mmHg
Is CSF production and flow affected by increase ICP?
Not really
What percent does the dural sinus pressure contribute to ICP?
90%
What is volume buffering?
Bascially the shift in something to make room for something else. This is usually CSF
What percent does CSF outflow resistance contribute to ICP?
10%
What is compliance?
Ability of that compartment to accomodate excess volume by shifting fluids within the compartment
What is the Monro-Kellie doctrine?
The sum of volumes of brain, CSF, and intracranial blood in constant under normal physioligcal conditions
What is the equation for compliance?
change in V / change in P
What is the medical treatment for increased ICP?
Treat underlying cause first
Hyperosmatics (mannitol or saline)
Corticosteroids (anti-inflammatory)
seizure management
Diuretics
In addition to diuresis, what else does mannitol help with?
reduces CSF production
What is cushing reflex?
Catecholamines lead to a systemic hypertensive state (systemic vasoconstriction and increased cardiac output) detected by baroreceptors, which in response trigger a vagally mediated bradycardia
At what point is the Cushing reflex triggered?
It is the last physiological defense mechanism for increased ICP
How fast should you administer mannitol and why?
Slowly (15-20 min) or it will cause massive vasodilation
What are 2 things that play into the brain’s buffering capacity?
Temporal lobe lesion is bad
Quick lesion expansion is bad
How long does mannitol last?
Only 2-5 hours
Is furosemide a long term solution?
No
Most of the medical options arent
When should hypertonic saline be considered over mannitol?
If concurrent hypotension is also present
What is death from a traumatic brain injury caused from?
Increase in ICP
What is a primary injury of the head?
Associated with impact
*** Passed a certain point, small changes in volume cause large changes in pressure (Increased ICP)
What are some examples of primary head trauma that can be addressed by the surgeon?
Depressed skull
Hemorrhage
Hematoma
What is a secondary injury of head trauma?
Sequelae fo primary injury
Is intracranial hemorrhage common in pets?
Thought to be
What are the ABCs of trauma patients
Airway
Breathing
Circulation
What does MGCS stand for?
Modified Glascow Coma Scale
What should be done to assess a trauma patient?
Neurologic exam
(specific attention to brainstem)
Should you fluid restrict a shock patient?
NEVER!! Correct shock quickly
What is teh #1 thing to pay attention to with polytrauma patients?
Respiratory complications
/Is there evidence of steroids helping trauma patients
No!
What are 4 indications for surgery?
- Unstable or depressed skull fracture
- Perforating wound to intracranial space
- Breach of barrier (head)
- Hemorrage not responding to medical management
What is a metabolic cause of peripheral vestibular disease?
Hypothyroidism
What are 4 steps to medical management of trauma patient?
- Mannitol
- Moderate hypothermia (inflammation)
- Oxygenate
- Elevate the head
What are 3 total reasons for peripheral vestibular disease?
hypothyroidism
Otisis media/interna
Idiopathic
What are 5 central causes of vestibular disease?
Neoplasia
MUO
Infectious
Toxin
Vascular
What are the 3 parts to the modified glascow coma scale?
Motor activity
Brainstem reflex
Mental status
Should advanced imaging almost always be on you diagnostic list?
Yes!
What is the #1 treatment for vestibular disease?
Treat underlying disease
For vestibular disease, what are the top 2 diagnostics whether its peripheral or central?
Blood work
Thyroid test
What is the likely toxin cause of vestibular disease?
METRONIDAZOLE!
What do you need after diagnosis of otitis?
Myringotomy - flushes and cultures fluid
Making a list of supportive care options for vestibular disease
Antiemetic
Sedation if needed
Padding and recumbancy care
IV fluids
Rehab exercise
What may need to be done for otitis in refractory cases?
Ventral bulla osteotomy
How long do you need to treat otitis with antibiotics?
At least 8 weeks, treat bone infection!
What is the prognosis of immune mediated, infectious, and neoplastic?
Guarded/poor (the rest we talked about are good)
How do you treat metronidazole toxicity?
Remove drug, recovery is 1-2 weeks
Diazepam too? not sure why
What is paroxysmal dyskinesia?
Brief, recurring episodes of uncontrolled movements
What are some therapeutic treatment trials for paroxysmal dyskinesia?
GLUTEN-FREE DIET
Keppra
First step in treating paroxysmal dyskinesia?
Determine if it is a seizure or not
Determine if it needs to be treated
Determine triggers
What do you need to avoid in grain free diets?
No wheat, barley, or rye
Avoid cross contamination
Need prescription diets
Is gluten free the same thing as grain free?
No!
How long before determine if there is a response to therapy?
4-8 weeks
What should the owner keep with paroxysmal dyskinesia?
Episode log
What are the 3 types of seizures?
Focal onset
Focal onset with secondary generalization
Generalized onset
What is the most common type of seizure
Focal onset with secondary generalization
sorry… what are 5 reasons to start a seizure med?
Status epilepticus or seizure clusters
Post-ictal complications
Identified structural cause
>2 seizures in 6 months
Worsening seizure frequency
When should you increase ASM?
Seizures are not controlled
Don’t adjust Anti seizure medicine (ASM) too fast. Pharmacokinetic (time to steady state)
When should you add another ASM?
When first ASM is maxed out
When should you decrease ASM?
Unacceptable and lasting side effects
***What is a “terrible job” of monitoring epilepsy?
Side effects with no therapeutic improvement
No specific treatments of episodes of status epileptics or cluster seizures
What drug is most effective, what drug is most safe?
Effective - pheno
Safest - keppra
What is a specific interaction with KBr?
NaCl fluids!
Where is pheno metabolized?
Liver
Where is KBr metabolized?
Kidney
What is time to steady state?
How long until dog is covered
***What is the mechanism of action of benzos?
Potentiate action of GABA at receptors (pre and post Cl channels)
What is the dosage of diazepam?
1mL/10kg
What is mechanism of action of keppra?
binds to synaptic vesicle protein SV2A
What is half life of keppra?
2-4 hours
What is an important drug interaction of keppra?
Pheno
What is mechanism of action of pheno?
Enhancement of post-synaptic neuronal responsiveness to GABA (opening of the Cl ion channel for longer time)
**What is the time to steady state of pheno?
10-20 days
Lots of side effects with pheno: Sedation, ataxia, polyphagia, PU/PD, hepatotoxicity
Should you use propofol?
No!
What is the time to steady state of bromide salts?
100-200 days!
How are bromide salts excreted?
Unchanged in urine (***Something important about equilibrium with Cl and diet)
Should you start with ketamine? Why?
No, ketamine can be a pro-convulsant
What are the 5 steps to status epilepticus?
Step 0: Diazepam - IV
Step 1: Diazepam - IV up to 3 times + ABC
Step 2: Keppra up to 3 times
Step 3: Pheno
Step 4: Ketamine IV
***What can be used instead of midazolam that lasts longer for cluster seizures (24-48hrs)
Clorazepate
How long does midazolam stay effective for cluster seizures?
1 hour
In terms of LMN signs, where would you find the lesion that causes it?
Cell body
Nerve
Neuromuscular junction
Muscle
What does the acronym RATS stand for?
Reflexes
Atrophy
Tone
Stride
What does neuropathy mean?
Disease of nerves
With LMN signs, what are the RATS?
Reflexes - decreased to absent
Atrophy - severe/fast
Tone - decreased to absent
Stride - short and choppy
With UMN signs, what are the RATS?
Reflexes - normal to increase
Atrophy - Mild/slow
Tone - Normal to increased
Stride - Long and lopey
What does myopathy mean?
Disease of the muscle
What does junctionopathy mean?
Disease of the junction
What are teh 3 most likely DAMNIT schemes for acute generalized neuromusclar disease?
Inflammatory
Infectious
Toxin
What are 3 extra things you should look for on LMN disease diagnosis?
Creatinine kinase (muscle injury)
Acetylcholine receptor antibody titers (myasthenia gravis)
Chest rads for megaesophagus
What is an example of a junctionopathie?
Acquired myasthenia gravis
What are 2 toxins that can cause neuromuscular disease?
Tick paralysis
Botulism
What is acute idiopathic polyradiculoneuritis also known as?
Coonhound paralysis
What is a common clinical sign of acute idiopathic polyradiculoneuritis?
Change in bark (dysphonia)
Rapidly progressing tetraparesis (ascending)
What is a common history for coonhound paralysis?
Raw diet (chicken) and campylobacter infection
How do you treat acute idiopathic polyradiculoneuritis?
Supportive care (give time for them to get better)
NO STEROIDS
What is a pre-synaptic junctionopathy?
Disorder of ACh synthesis
What is synaptic junctionopathy?
Disorder of acetylcholinesterase
What is post-synaptic junctionopathy?
Disorder of Ach receptor
Where does acquired myasthenia gravis act?
Post-synpatic - attacks receptors
How long will coonhound paralysis take to get better?
At least 3-6 weeks, maybe 6 months
What is number 1 clinical history of m. gravis?
fatigue
What is the most severe version of m gravis?
Fulminant
What is the gold standard diagnostic for m gravis?
ACh receptor antibody titer
What is the specific treatment for M gravis?
Anticholinesterase therapy - Pyridostigmine bromide
How do you fead a patient with m gravis?
Bailey chair - during and 15 min after eating
What do you need to be ready with when using anticholinesterase?
Atropine from side effects!
Must start low and titrate up
What is the acronym for side effects for pyridostigmine?
SLUDD
S - salivation
L - lacrimation
U - Urination
D - Defecation
D - Dsypnea
Where does botulism (C. botulinum C most common) come from?
Carcass or spoiled meat
What is prognosis of fulminant cases due to aspiration pneumonia?
Grave
What is a common clinical sign of botulism/
Fish mouth
What is usually seen on radiographs?
Megaesophagus and ileus
What is the mechanism of botulism?
Ach not released, blocked by neurotoxin
What is treatment of tick paralysis?
Remove tick! Excellent prognosis
What is treatment of botulism?
Supportive care and time
What is most common type of polymyositis?
Immune-mediated polymyositis
What is generalized polymyositis?
Inflammatory disease of muscles
Are polymyositis cases usually painful?
No! just generalized weakness
High CK!
What is treatment of immune mediated polymyositis?
Prednisone!
What is important with client communication with all polyradiculoneuritis diseases?
Ensure them that it will take time, megaesophagus is unlikely to resolve, M gravis treatment is a moving target and may need to change over time, risk of relapse
Congrats, youre done!
