Track J.T. Vaughan Equine Conference Small Animal I Small Animal II Farm Animal Pharmacy 8:00 a.m. Welcome, Dean Calvin Johnson; 7:55-8:00 a.m. Advanced Diagnostic Imaging in Equine Ophthalmology 8-8:50 a.m. McMullen, DVM Mast Cell Tumors 8-8:50 a.m. Matz, DVM Welcome, Dean Calvin Johnson 8:55-9:00 a.m. Food Animal Neurology: Neurologic Exam & Lesion Localization 8-8:50 a.m. Washburn, DVM 9:00 a.m. Management of Hindlimb Gait Abnormalities 9-9:50 a.m. Caldwell, DVM Wound Management & Bandaging 9-9:50 a.m. Matz, DVM Cats Are Not Dogs When it Comes to Dentistry 9-9:50 a.m. Bellows, DVM Food Animal Neurology: Case Discussion 9-9:50 a.m. Washburn, DVM 10:00 a.m. Neurologic Examination: Choosing the Appropriate Diagnostic Test 10:10-11 a.m. Mora, DVM Feline Cardiomyopathies I: HCM Update 2020 10:10-11:00 a.m. Anderson, VMD 25 Surprising Hacks to Improve Your Dental Practice 10:10-11:00 a.m. Bellows, DVM Welcome, Dean Calvin Johnson; 10:05-10:10 a.m. FAMACHA: No it’s Not Spanish! 10:10-11:00 a.m. Washburn, DVM Opioid Use and Control 10:10-noon Duran, RPh & Miller, RPh 11:00 a.m. Lymphoma in Horses: What We Know & Don’t Know 11:10-noon Groover, DVM Feline Cardiomyopathies II: The “Other” Cardiomyopathies & Treatment Controversies 11:10-noon Anderson, VMD Demystifying Intraoral Radiology 11:10-noon Bellows, DVM Downer Bovids 11:10-noon Washburn, DVM 12:00 p.m. BREAK FOR LUNCH 1:00 p.m. Equine Gastric Ulcer Syndrome (EGUS): Why is it Such a Pain in the Gut? 1-1:50 p.m. Sanchez, DVM Welcome, Dean Calvin Johnson; 12:55-1:00 p.m. Systemic & Pulmonary Arterial Hypertension in Dogs & Cats 1-1:50 p.m. Anderson, VMD Recognizing & Approaching Early Chronic Kidney Disease 1-1:50 p.m. Langston, DVM Updates in the Standards of Failure in the Transfer of Passive Immunity (FTPI) for Dairy & Beef Calves 1-1:50 p.m. Chamorro, DVM * Florida Drug Dispensation & Veterinary Pharmacy Laws & Rules 1-4:00 p.m. Duran, RPh & Miller, RPh 2:00 p.m. Equine Wound Management 2-2:50 p.m. Reyner, DVM Canine Myocardial Disease 2-2:50 p.m. Anderson, VMD Don’t Let Hyperphosphatemia be Carved in Stone 2-2:50 p.m. Langston, DVM Vaccination of Dams During Gestation or Early Vaccination of Calves: Alternatives to Reduce BRD Preweaning 2-2:50 p.m. Chamorro, DVM 3:00 p.m. Three Critical Concepts for Utilizing Mare Assisted Reproductive Technologies in Your Reproductive Practice 3:10-4:00 p.m. Lyman, DVM ECGs for People in a Hurry 3:10-4:00 p.m. Anderson, VMD Special Aspects of Chronic Kidney Disease: Anemia & Hypertension 3:10-4:00 p.m. Langston, DVM Spermiogram: The Good, the Bad, & the Ugly 3:10-3:35 p.m. Waters, DVM Using the Intratesticular Route to Anesthetize Small Ruminants for Castration 3:35-4:00 p.m. R. Stockler, DVM 4:00 p.m. Burn Injury in Horses 4:10-5:00 p.m. Hanson, DVM Canine Degenerative Valve Disease: What Could Possibly be New? 4:10-5:00 p.m. Anderson, VMD Treating Chronic Kidney Disease 4:10-5:00 p.m. Langston, DVM Maternally-Derived Antibodies Protect Young Beef Calves Against Experimental Challenge with BRSV 4:10-4:35 p.m. Martinez, DVM Parasitic Otitis in an Adult Barzona Bull 4:35-5:00 p.m. Malmstrom, DVM 5:00 p.m. AWARDS RECOGNITION Bailey Distinguished Alumni, El Toro, and Vaughan Equine Achievement Awards 5-5:30 p.m. 2020 Annual Conference Schedule Thursday, October 22 = Sponsored by Royal Canin = Sponsored by Boehringer Ingelheim = Sponsored by Merck Animal Health = Sponsored by Seminole Wellness * available in live format only, not included in on demand sessions
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Transcript
Trac
k J.T. Vaughan Equine Conference Small Animal I Small Animal II Farm Animal Pharmacy
8:00
a.m
.
Welcome, Dean Calvin Johnson;
7:55-8:00 a.m.
Advanced Diagnostic Imaging in Equine Ophthalmology
This presentation will cover non-pharmacological options for pain management. Typically, pain is treated or managed with a combination of medications including NSAIDs and opioids. But there can be a risk of side effects that can compromise a patient’s overall health. A patient may not tolerate NSAID therapy though the effects of inhibiting inflammation are needed to decrease pain perception. We are going to examine non-traditional or non-pharmacological methods to aid in pain management. These techniques can be used in conjunction with pain medications to achieve a multimodal approach to pain management.
There are numerous non-pharmacological options to manage pain available including: thermal modalities, massage therapy, therapeutic laser, therapeutic ultrasound, electrical stimulation, extracorporeal shockwave, targeted pulsed electromagnetic field therapy, and acupuncture. The physiological effects and mechanisms of action will be discussed, as well as the indications and contraindications.
This presentation will cover non-pharmacological options for pain management. Typically, pain is treated or managed with a combination of medications including NSAIDs and opioids. But there can be a risk of side effects that can compromise a patient’s overall health. A patient may not tolerate NSAID therapy though the effects of inhibiting inflammation are needed to decrease pain perception. We are going to examine non-traditional or non-pharmacological methods to aid in pain management. These techniques can be used in conjunction with pain medications to achieve a multimodal approach to pain management.
There are numerous non-pharmacological options to manage pain available including: thermal modalities, massage therapy, therapeutic laser, therapeutic ultrasound, electrical stimulation, extracorporeal shockwave, targeted pulsed electromagnetic field therapy, and acupuncture. By combining modalities and medications we are able to treat pain more effectively using a
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Thermal modalities cover both cold and heat applications. They act in different ways and are used at different times, but they both help reduce pain.
Cryotherapy or icing as most of us call it, is often used after surgery. It is a superficial treatment meaning we place the ice pack in a towel on the skin and allow the cold to penetrate the body. The cooling effects only penetrate 1-4 cm of tissue depth and the depth depends on the adipose layer and blood supply. For this reason, cryotherapy is more efficient on distal limbs than on the truck of the body. When applying ice, you typically are going to treat the area for 10-20 minutes for maximum cooling but you need to be sure you are checking the temperature and color of the skin.
What are the physiological effects of cryotherapy and how do they translate into pain management? Cryotherapy causes vasoconstriction. When the blood vessels constrict, blood flow to the area decreases and since there is the vessels are technically smaller, pressure on nociceptors is decreased and that decreases pain. The vasoconstriction also aids in decreasing the edema of the surrounding tissues. Because there is less blood supply coming into the tissues, cryotherapy decreases enzyme-mediated tissue damage by minimizing the release of histamine and also slows the metabolic rate of the surrounding tissues. With the metabolic rate of the tissues slowed, the reaction rate related to acute inflammation also slows. Cryotherapy also decreases nerve conduction velocity, so pain signals in the area that are iced don’t get through as quickly. Because the nerve conduction is slowed and pain doesn’t travel as quickly through the nerves, it provides analgesia.
The analgesic response is medicated by the peripheral nervous system. The nerves in the limbs send signals to the brain to signal pain. Because the cold receptors in the area being iced are overstimulated and the nerve conduction is decreased, the pain signal is stopped at the spinal level and does not reach the brain. The term for this theory is Spinal Gate Control Theory of Pain Transmission. With the slowed signal conduction and the decreased metabolic rate of the tissues being iced, the refractory period of the cells increase and they are unable to transmit a pain signal for longer periods of time. The increased refractory period and slowed nerve conduction also allow for a decrease in reflexive muscle spasms. With fewer or weaker muscle spasms in the surrounding tissue, pain is reduced.
There are three physical mechanisms of cryotherapy which allow us to apply cryotherapy in various ways to reach our goal of decreasing pain. Conduction is the most commonly used mechanism in veterinary medicine. Typically ice packs, ice massage, or cold compresses are used. A good example of this is icing a limb or incision after surgery. Another mechanism is convection. An example of convection is an ice bath. This is not something we tend to do is veterinary medicine because it isn’t the most pleasant experience. The third mechanism is evaporation. A vapo-coolant spray is applied directly to the skin and heat is reduced in the area through evaporation. We don’t tend to use this in veterinary medicine because of the fur.
There are many reasons to use cryotherapy. Icing is used during the acute pain phase of soft tissue injuries. The acute pain phase is the first 72 hours following an injury. Icing an incision following surgery
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is an example of icing during the acute pain phase. It is also used to decrease edema to traumatized area. This occurs because of vasoconstriction. Cryotherapy can be used to help decrease pain in joints that is caused by chronic osteoarthritis. When there is osteoarthritis in a joint, there is a constant low-grade inflammation that causes pain and the ice helps to decrease the inflammation in the joint and slows the transduction of the pain sensation. Ice can also be used following physical rehabilitation to help with decreasing inflammation caused by exercise.
When applying cryotherapy there are some precautions that need to be taken. You should be very careful using ice on patients with cardiac conditions or high blood pressure because of the vasoconstriction that is induced. Also care should be use when applying ice to open wounds because the vasoconstriction can damage the delicate capillaries in the area. And when icing an area with superficial nerves, ice will not need to be applied as long since the nerves are closer to the skin and there is less insulation to protect the nerves. There are contraindications for cryotherapy that include cold hypersensitivity and altered skin sensation. It is possible to cause frost bite if you do not monitor the temperature and color of the skin appropriately.
The other thermal modality is heat therapy. There is superficial heating of the skin that penetrates 2cm deep. This is usually accomplished through warm packs or rice mamas. There is also deep heating that penetrates up to 5 cm deep and typically uses therapeutic ultrasound. When applying superficial heat the treatment time is 15-20 minutes every 4 to 6 hours. It is very important to monitor the skin temperature and color when using heat to avoid burns.
The physiological effects of heat therapy are opposite of cryotherapy. Heat therapy primarily causes vasodilation. This vasodilation allows for increased blood and lymph flow in the treated area. Because there is more blood flowing into the tissues, there is increased oxygenation of the tissues and leukocyte migration is increased. Since the cells and tissues are more active the metabolic rate of the cells increases as well. The heat also provides an element of relaxation that decreases muscle spasms in the tissues. With muscle spasms released, the soft tissue is able to move more freely and the tissue becomes flexible.
Heat therapy provides analgesia or pain relief primarily through vasodilation, but there is a cascade of events that must take place first. Heat increases the activity of cutaneous thermoreceptors. The increased activity in the thermoreceptors activates a release of bradykinin and nitrous oxide which causes the relaxation of smooth muscles in the surrounding blood vessels. With the smooth muscles in the blood vessels relaxed, vasodilation occurs. The relaxation of smooth muscles also allows for decreases in muscle spasms which leads to decreases in pain. Vasodilation is also caused by decreased sympathetic output. The heat also increases sensory and motor nerve conduction velocity which allows signals to travel more rapidly to the spinal cord. Heat increases soft tissue extensibility, most notably the collagen fibers in the soft tissue. With increased extensibility, the muscle is able to maintain a stretch completed during range of motion for longer periods of time and gradually lengthens the muscle fibers.
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Like in cryotherapy, there are three physical mechanisms of heat therapy which allow us to apply heat in various ways to reach our goal of decreasing pain. Conduction is the most commonly used mechanism in veterinary medicine. We typically use warm packs or warm water hydrotherapy. A good example of this is warm packing a seroma. Another mechanism is convection. An example of convection is a warm water bath or using a hair dryer to warm a patient. The third mechanism is radiation. Using UV lights or infrared lights to heat a patient are examples of radiation.
There are many reasons to use heat therapy. Warm packing is used during subacute inflammatory phase. The subacute inflammatory phase is 3-4 days following an injury. Warm packing an incision starting 3 days after surgery is an example of warm packing during the subacute inflammatory phase. Heat therapy can also be used to help relieve pain caused by chronic inflammation. The heat allows for vasodilation which brings more nutrient rich blood into the tissues and aids in relaxation. The relaxation of the smooth muscles also decreases muscle spasms that may be present. Heat is also beneficial following traumas such as sprains, strains, and myositis. The increased blood flow allows migration of cells needed to repair the damaged tissue. Another reason to use heat therapy is in cases of decreased joint range of motion. When a joint is unable to move in a normal manner, the supporting soft tissues become less extensible and are unable to stretch in properly. By heating the muscles, we are able to increase the extensibility of the collagen fibers in the muscles, allowing for a more complete stretch.
When applying heat therapy there are some precautions that need to be taken. You should be very careful using heat on patients that are pregnant. Also use caution in patients with cardiac insufficiency or impaired circulation because of the vasodilation that is caused by heat therapy. Patients that are extremely obese are sometimes unable to properly regulate their body temperature and caution should be used in these patients. Care should also be used in patients suffering from bursitis or tendonitis. These conditions benefit more from the application of cryotherapy. There are a number of contraindications for heat therapy which include: active hemorrhage (the application of heat would increase blood flow to the area), acute inflammation (cryotherapy should be used during the acute phase), thrombophlebitis or embolism (vasodilation would be detrimental to the patient’s overall health and wellbeing), or altered sensation to the skin (heat packs can cause serious burns if not monitored properly). Patients with malignancies or infection should not receive heat therapy due to the increased circulation in the area and the migration of cells in and out of the area being heated. Also, if a patient is febrile, the use of heat would only increase the patient’s temperature leading to a more serious or longer lasting fever.
Another approach to managing pain is the use of massage therapy. Massage therapy is a manual therapy that combines manipulation of soft tissue and stretching. It is beneficial to incorporate range of motion into a massage to allow increased stretching of the soft tissues surrounding joints. There are many benefits and physiological effects of massage therapy including increasing lymph and blood flow and maintaining soft tissue extensibility. It causes a natural release of endorphins which decreases anxiety and tension and increases relaxation.
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Massage is not just gently rubbing on a muscle, there are a number of techniques use for different tissue conditions to gain the desired results. It is important not to overwork the muscle because it can become bruised or sore to the touch.
Stroking is a technique that involves rubbing your hands on the animal moving from neck to tail. This allows you to assess the soft tissues and muscle tone. This is completed at the beginning of a massage and allows you to find specific areas of tension to focus on during the massage with other techniques.
Effleurage is a technique that involves working from the distal limb proximally. This aids in decreasing swelling and aids in drainage by using gentle pressure on the limb to manually move toxins towards lymph nodes. This technique is useful if a patient has swelling of the lower limb following surgery.
Petrissage is a technique used for deep tissue massage. It involves using kneading or wringing motion and skin rolling. This technique is used to compress underlying tissues.
Compression is a technique used to increase muscle tone is some muscles, typically the triceps and deltoids. In other muscles it is used to decrease muscle tone by increasing circulation in the tissues. To perform this technique, using the heel of your hand apply direct and constant pressure to the muscle belly and hold the pressure for 15 seconds. This can be repeated several times but do not overwork the muscle.
Holding and placing is a technique used to increase local circulation and relaxation in muscles that are in spasm. To complete this technique a hand is placed over the muscle that is in spasm and hold your hand there for several seconds. This traps heat in the specific muscles being covered.
Percussion is a clapping, hacking, or pounding a muscle using a cupped hand. This technique is used in areas of muscle weakness. It increases relaxation and generalized circulation.
There are two targeted massage therapies that are used for specific soft tissue issues. Trigger point therapy is one. A trigger point is a knot in the muscle, much like a tension knot in people often get in their necks. To complete this therapy, isolate the knot in the muscle. Place your fingers on either side of the knot and apply firm pressure to the knot and hold for 20 seconds. Release the knot for 10 seconds and repeat this 3-4 times. You can typically feel the knot melt away. If you have a knot in your neck you can easily try this on yourself.
The other targeted massage therapy is deep transverse friction massage or cross friction massage. This technique is less comfortable than other massage techniques. It is used to decrease scar tissue formation within the muscle. To complete this technique, massage at a 90 degree angle to the muscle belly, like strumming a guitar string. Complete ten strokes for 3-4 repetitions. After completing the strokes, finish with a gentle massage. It is important to not over work the muscle with this technique.
There are many indications for massage. It can be used: in patients with mechanical or postural changes due to compensatory injury following injury or surgery, to decrease scar tissue formation, or in patients with fatigue or muscle soreness. Massage aids in decreasing muscle tone and tension. It can be used in patients with low-grade inflammatory conditions like osteoarthritis or when an increase in blood flow is needed. It is also used frequently in canine and equine athletes to help in recovery following
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completions and to improve their athletic performance. It is important to allow at least two hours between a workout and completing a massage.
There are also reasons for a patient not to receive a massage. If a patient is in shock it do not perform massage on a patient because it can lower the blood pressure further. Also, avoid massage in patients with a fever or acute inflammation or infectious disease because of the increase in circulation caused by massage. Patients with acute viral disease like Herpes should not receive massage because of the increased in circulation and decreased blood pressure. And if a patient has dermatologic condition do not massage them because of the possibility of introducing bacteria to the area, or spreading the bacteria to broken skin.
Therapeutic laser or photobiomodulation is a modality used to aid in pain management. It aids in modulating cellular function using light waves. There are Class 3b and Class 4 therapeutic lasers that vary in strength. The class 4 lasers are stronger and take less time to deliver the prescribed amount of Joules to the tissue. The wavelength of the laser determines how deep the energy is able to penetrate. There are superficial neurons within the treatment depth allowing the energy to act on the neurons and stimulate the physiologic effects.
There are many physiological effects including vasodilation and inhibition of inflammation. There is an increased release of endorphins and enkephalins leading to a decrease in pain. Photobiomodulation also promotes nerve recovery and wound healing through modulating cellular function and increasing blood flow to the area allowing for migration of cells and nutrients to the area being treated.
The exact mechanism of action of laser therapy is unknown. It is thought that laser therapy can influence pain perception either directly or indirectly by acting on nociceptors and modulating inflammation. It may suppress central sensitization resulting in a long-term depression of persistent pain with repeated treatments. On this case it is thought that if you continue to treat an area the effects of pain reduction will last longer between subsequent treatments. It also appears that sensory nerves are preferentially affected which causes inhibitory effects on pain receptors causing pain reduction.
There are many indications for therapeutic laser therapy. It is used for wound management to decrease healing time. It aids in pain management and decreases inflammation and edema. It often used for osteoarthritis and the pain associated with osteoarthritis. Because of the effects on nerve healing, it can be used in cases of neurologic dysfunction like degenerative myelopathy and nerve injury. It can be used for post-operative incision care as well as soft tissue injuries.
While there are many uses for therapeutic laser, there are contraindications and precautions that should be considered when deciding treatment options. Therapeutic laser should not be used in patients with neoplasia or open growth plates in puppies or open fontanels. A concern using laser in neoplasia patients is that it could possibly spread cancerous cells. Using laser in puppies or kittens can cause premature closure of growth plates. Laser should not be applied to pregnant abdomens or near eyes. The laser can cause blindness if the beam is direct towards the eye. Because the laser is a heat source, caution should be used when patients have dark skin, tattoos, or are taking medications that cause photosensitivity. It is also important for the patient and anyone in the area should wear special protective eyewear when the laser is in use. The laser should be applied in a grid pattern with the head constantly moving to avoid burns.
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Therapeutic ultrasound is another modality used in pain management. It is a deep penetrating heat that requires a coupling agent like ultrasound gel. Ultrasound uses one of two frequencies depending on the depth of the tissue that is being treated. A frequency of 1 mHz penetrates 2-5cm and causes enhanced cell proliferation. A frequency of 3.3 mHz penetrates 0.5-3cm. The intensity setting determines the rate of energy delivery. Typically the intensity is 0.5-5 W/cm2.
The physiological effects of therapeutic ultrasound are numerous. It increases collagen extensibility and soft tissue temperature allowing for improved stretching of the soft tissues in the limbs. Since it is a deep penetrating heat, it causes vasodilation and increases blood flow to the area being treated. It increases the pain threshold. When used in conjunction with topical anti-inflammatory drugs, it is able to drive the drug across the skin by phonophoresis.
Therapeutic ultrasound is used for musculoskeletal conditions like contracture. It is used in contracture to increase collagen extensibility allowing for more stretching and improving range of motion. It is beneficial in cases of scarring and soft tissue calcification. The frequency aids in disrupting scar tissue and calcification in soft tissue allowing muscle fibers to be manually massaged into a more normal position. It can decrease pain and muscle spasm through vasodilation. And is useful in treating subacute and chronic inflammation and wound healing.
There are many precautions and contraindications for using therapeutic ultrasound. Caution should be used when applying ultrasound over bony prominences due to a risk of burning. It is also not recommended to use during the acute inflammatory phase because of the heat and vasodilation it causes. Caution should also be used in patients with decreased circulation or sensation. It should not be used in patients with pacemakers or over the heart because it can alter the heart rhythm. It should not be used immediately after exercise or in patients with neoplasia or open growth plates because of vasodilation and premature closure of growth plates. It is very important to keep the ultrasound head moving and monitor the skin because of the risk of burning the patient.
TENS is electrical stimulation used for pain management. TENS stands for transcutaneous electric nerve stimulation. It uses low frequency (50-150 Hz) and low intensity that is gradually increased. There is no muscle contraction elicited. It is often used in humans after chiropractic adjustments. It feels like tingling or pins and needles. TENS is only used for pain control.
The physiologic effects of TENS are decreasing central sensation and primary hyperalgesia. It also causes a release of endogenous opiates leading to pain relief. TENS acts using the Gate Control Theory to provide pain relief. It stimulates faster sensory nerves with electrical impulses causing an overload of interneurons. This limits the ability of the sensory nerves to transmit pain signals to the brain. It basically causes overstimulation of the nerves and prevents pain signals from moving to the brain.
When using TENS caution should be used when applying the electrode pads in areas with decreased sensation or over sensitive skin. The pads can cause skin irritation if the patient has sensitive skin. Also be sure not to place the pads near ECG leads because it will interfere with the ECG readings. Electrodes should not be placed directly over the heart or the carotid sinus. The electric stimulation can adversely affect pacemakers and should not be used in patients with pacemakers. TENS should not be used in patients with a history of seizures and over areas of thrombosis, infection, or neoplasia.
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Extracorporeal shockwave therapy is used in some cases for pain management. It uses radial or focused shockwaves to penetrate to deeper tissues. Radial shockwaves provide a broad field of treatment. Focused shockwaves have a more narrow field of effect. In older units heavy sedation or general anesthesia is required for administration. It can be very painful over lightly muscled areas.
The physiological effects of shockwave therapy include improving weight bearing and passive range of motion similar to using NSAIDs . It is particularly effective when used on the elbows, hips, and back. It alters nerve function in the treated areas producing analgesia. It increases cytokine and growth factor production allowing for increased healing in treated areas. It also increases endothelial nitric oxide synthase and upregulates bone morphogenetic protein expression which is why it can be beneficial in delayed union fractures.
The exact mechanism of action in Shockwave Therapy is unknown, but like TENS, it is believed that it works using the Gate Control Theory. It causes hyperstimulation of nociceptors and prevents pain signals from reaching the brain by promoting descending inhibition and modulation of sensory stimulus transmission. It also causes cell damage that prevents the membrane potentials required for signal transmission from being achieved.
Shockwave is beneficial in cases of osteoarthritis and controlling the pain associated with osteoarthritis. Because of its effects on growth factor production and bone morphogenetic protein expression, it can be used in delayed union fractures and non-union fractures. It is used in tendonopathies and ligament conditions because of the increase in cytokine and growth factor production it stimulates. It can be used in large wounds during the acute phase of the injury to aid in healing.
While shockwave therapy is beneficial in certain cases, it should be used with caution in young and developing with open growth plates. It can cause premature closure of growth plates and in some cases it can fracture small bones. It should not be used in immune mediated joint disease, infectious osteoarthritis, or diskosponylitis. Unstable fractures should not be treated with shockwave therapy because of the likelihood of displacing the fracture. It should also not be used in neurologic patients because of decreased sensation and the potential to cause injury. Never apply shockwave therapy over the lungs, heart, gravid uterus, brain or neoplasia. It is important that shockwave therapy can be painful and cause bruising and petechial over the treated areas.
Another modality used to treat pain is targeted Pulsed Electromagnetic Field therapy. A portable unit that is available through Assisi Animal Health is the Assisi Loop. It is a Non-steroidal anti-inflammatory device that is approved by the FDA. The device is placed over the area to be treated and turned on to run for 15 minutes. The treatment can be repeated up to four times a day but requires at least two hours between treatments.
The physiological effects of tPEMF include increased bone and tissue healing. It promotes ion transport across cell membranes which improves cell metabolism. It works on the Calcium ion channels and increases the binding of calcium to calmodulin leading to an acceleration in the nitric oxide cascade. It also stabilizes the intracellular calcium stores by altering formation of calcium channel proteins by decreasing mitochondrial free radicals leading to decreased inflammation.
TPEMF therapy is used to decrease pain and inflammation associated with osteoarthritis and hip dysplasia. It can also be used to decrease edema and spinal cord injuries. It is also beneficial in treating
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pain and inflammation associated with surgery cystitis. The only contraindication associated with tPEMF therapy is pacemakers in the patient and the person administering the therapy.
Acupuncture is a modality used to manage not only pain but many other conditions. Acupuncture is traditional Chinese medicine that has been practiced for more than 2,000 years. It is used in a wide variety of animal patients, including: horses, cattle, dogs, cats, and birds, in addition to humans. There are specific acupuncture points that lie along meridians. Meridians are considered the energy channels of the body and there are 14 meridians and 361 specific acupuncture points.
The acupuncture points are stimulated by inserting needles into the points. The needles are a pointed filiform that comes in a variety of gauges. The acupuncture needles do not cut the tissue rather they separate the tissues. Inserting the needles is not typically painful.
There are many physiological effects associated with acupuncture. Stimulating acupuncture points activates A-alpha and A-beta nerve fibers causing a release of beta-endorphins. Through stimulating nerve fibers serotonins are activated and there is a release of endogenous opioids. The stimulation also activates the pain inhibitory pathway that leads to pain relief. Acupuncture also regulates blood pressure and stimulates the immune system leading to an increase in white blood cells and T-lymphocytes in circulation.
Acupuncture is used to achieve many goals to aid in the overall health is patients. It is used to release physical and emotional stress. Typically patients receiving acupuncture relax quickly and will sometimes fall asleep during their treatment. It activates and controls immune and anti-inflammatory mechanisms. It can be used to accelerate tissue healing by increasing white blood cells and T-lymphocytes in circulation and stimulating the immune system. Often times it is used for pain relief that is caused by the release of serotonin and endorphins.
There are many types of acupuncture or methods to perform acupuncture. Dry needling is the most common method. Needles are inserted into specific acupuncture points and allowed to sit in place for 10 to 20 minutes. Moxibustion is used to activate acupuncture points through heating the points. It is performed by burning Chinese ragweed over the point with or without inserting a needle into the point. Never touch the burning moxa to the skin and caution should be used in the summer because the purpose of moxibustion is to increase the heat in the body. It should also be completed in a well ventilated area because of the strong smell associated with the smoke.
Electro-acupuncture is more effective than dry needling and is used to continuously stimulate acupuncture points for a prolonged period of time. An electrical current is delivered through the needles with the frequency and amplitude being controlled. The frequency is adjusted based on the condition that is being treated. The treatment is typically between 10 and 30 minutes. This is done in conjunction with dry needling.
Aqua-acupuncture is the process of injecting a solution into an acupuncture point to provide repeated stimulation of the acupuncture point. As the solution is absorbed, the pressure in the acupuncture point changes causing a repeated stimulation of the acupuncture point. Vitamin B12, saline, and sterile water are commonly used in aqua-acupuncture.
Hemo-acupuncture is used to release heat from the patient. A hypodermic needle is inserted into acupuncture points along blood vessels. When the patient bleeds, heat is released from the body.
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Acupressure is a technique that does not use needles to apply pressure to acupuncture points. Digital pressure is applied to acupuncture points with five to ten minutes of constant pressure. This technique removes the need for needles and still allows the points to be stimulated. Though it is not as effective, it can still stimulate the points to gain benefits.
There are many pain conditions that are treated with acupuncture. It is used to release trigger points and musculoskeletal pain. It is beneficial in geriatric patients with chronic lameness, osteoarthritis pain, lumbosacral, cervical, and thoracolumbar pain. It can also be used for more acute conditions related to exercise injury like biceps tenosynovitis. It can also be used for pain associated with colic in horses. Caution should be used in patients that are weak, debilitated, or pregnant. It is important to start with fewer points being stimulated and build the number based on how the patient responds. Electo-acupuncture should not be used in patients with seizures and pacemakers. Patients with neoplasia should not receive acupuncture in points near the tumor.
In conclusion, when managing pain in patients it is beneficial to use a multimodal approach. By incorporating different modalities into the plan, it is sometimes possible to decrease the amount of pain medications based on the patient’s response. It is important to manage a patient’s pain to improve their overall quality of life.
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MAKING SELF CARE A PRIORITY AND AVOIDING COMPASSION FATIGUE AND BURNOUT Mary-Catherine Turner Licensed Professional Counselor Auburn University 1180 Wire Road Veterinary Education Center, Room 135 334-844-5123 334-844-6110 (fax) [email protected] Burnout and compassion fatigue are common concerns with individuals who work in health care, veterinary health care especially. Those who attended the American Veterinary Medical Association conference reported that stress, burnout, and compassion fatigue were the most important wellness concerns that were prevalent in the veterinary community. These same individuals reported there are not resources readily available to those in veterinary medicine professions to address these concerns. The unique circumstances in veterinary medicine contribute to increased risk of burnout in veterinary related professions. Individuals who chose their profession as one in veterinary health care are usually those with increased compassionate and empathetic personalities and attributes. Witnessing another person’s painful traumatic experiences and encountering illness and death on a daily basis can lead to compassion fatigue. Compassion fatigue by definition is exhaustion due to the demands of being empathic and helpful to others who are suffering. Continuously experiencing compassion fatigue can lead to burnout which can be the end point for some individuals in their chosen profession. The ways to address, manage, and decrease compassion fatigue that leads to burnout starts in the workplace. Developing resources with individuals and as a team to address the symptoms associated with burnout and compassion fatigue is vital to performance and wellbeing. Individuals have a responsibility to care for themselves as well as care for their professional responsibilities in the healthiest way. Developing a self-care action plan can assist in identifying and addressing your needs and ways to incorporate a plan into daily routine. Building resilience is imperative in veterinary professions to manage and avoid compassion fatigue and burnout. Keywords: self-care, compassion fatigue, burnout, wellness, mental health Compassion fatigue is exhaustion due to the demands of being empathetic and helpful to others who are suffering. Veterinary professionals are susceptible to compassion fatigue due to dealing with death and dying on a daily basis. Research shows that veterinary professionals deal with ethical decisions three to five times per week, this large load of moral stress can lead to compassion fatigue and burnout. Burnout is the end point in the veterinary profession for some individuals. Signs and symptoms of compassion fatigue are many, the following are a few examples: sadness and apathy, difficulty concentrating, lack of self-care, mental and physical exhaustion and isolation from others. Stress can lead to distress or negative wellbeing. Eustress or positive stress, is the action enhancing stress that keeps individuals motivated for life. The balance of these is very important to effective functioning in daily life. Self-care is an important addition to build resilience and assessing a self-care plan can assist in identifying and addressing your needs to add into your daily routine. Self-care is the act of caring for yourself, is any
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activity we do deliberately to care for our mental, emotional, and physical health. Self-care and addressing this need is just as important as completing job responsibilities. Personal strategies for self-care may include lifestyle changes, adopting a healthier lifestyle, reduction of working hours, and ensuring adequate sleep. Incorporating things like adequate nutrition and sleep, physical activity, and active relaxation to routine can assist in building resilience. Awareness of compassion fatigue and burnout are also key to avoiding these. Developing a self-care action plan begins by addressing strengths and areas for growth in this area. Targeting each area of mental, emotional, and physical health by developing positive coping strategies in each area. References
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6. Work and compassion fatigue [Internet]. American Veterinary Medical Association. 2020 [cited 11 September 2020]. Available from: https://www.avma.org/resources-tools/wellbeing/work-and-compassion-fatigue