case study - mspca-angell

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Figure 1: Kyro began treatment through thePain Medicine Service at Angell-Boston torelieve discomfort that developed after years ofa complex medical history.

The MSPCA-Angell is a national and international leader in animal protection and veterinary medicine. Founded in 1868, it is the second-oldest humane society inthe United States. Services include animal protection and adoption, advocacy, humane education, law enforcement and the highest-quality veterinary care availableanywhere in the world. The MSPCA-Angell provides direct hands-on care for more than 250,000 animals each year through its Animal Care and Adoption Centersand world-class Angell Animal Medical Centers. For more information, please visit www.mspca.org.

PAIN MEDICINE

CLINICIANLisa Moses, DVM, DACVIM

PATIENTCurrently a 15-year-old mixed-breed dog

HISTORY ANDPRESENTING CONCERNKyro is a very tough 15-year-old mixed-breeddog who was adopted from the MSPCA AnimalCare and Adoption Center-Metro South as apuppy. Kyro has a long and complex medicalhistory that includes chronic liver enzymeelevations and multiple surgeries at Angell-Bostonfor both thoracolumbar IVDD and rupturedcranial cruciate ligaments. As a result of his IVDDand ruptured cruciate ligaments, he had chronicpain and immobility of both stifles and histhoracic, lumbar and sacral spine, in addition toosteoarthritis of both coxofemoral joints, his tarsiand both shoulders.

About four months prior to presentation to thePain Medicine clinic, Kyro had two episodes ofacute vestibular deficits during both of which hefell down stairs at home. Although he was notseverely injured during either fall and theconcurrent nystagmus resolved quickly, he wasleft with a head tilt and balance deficits.Examination by Angell-Boston’s NeurologyService suspected stroke episodes, although theowner declined a brain MRI to confirm this.

Dr. Joel Kaye, Kyro’s primary clinician referred himto the Pain Medicine Service to achieve severalgoals. Dr. Kaye and Kyro’s owner wanted hisosteoarthritis pain better managed, but alsowanted to improve his balance so he could shakewithout falling over and turn around in a corner.It was hoped that working on both these goalswould allow Kyro to again behave normally suchas getting on the sofa without assistance andrunning up and down the driveway with theneighborhood kids.

DIAGNOSIS/TREATMENTSimilar to Pain Medicine Service patients with acomplex medical history, the first step was acomprehensive evaluation of his overall health,organ function, current limits on mobility andassessment of pain. After this was accomplished

during his initial evaluation appointment, wesettled on a multi-modal approach to hisproblems. He was started on several medicationsfor chronic pain including a reduced dose of anNSAID, a home exercise program was createdfor him to help improve his balance andproprioception and electro-acupuncture werebegun to provide a side effect-free method ofcontrolling pain and improving vestibular deficits.

FOLLOW UPWithin three weeks of beginning treatment, Kyroresumed many of the behaviors that he had notexhibited in the past year. Over treatment in thesubsequent two months, his owner reported thathis attitude and energy level had returned towhat they were years ago. After more than sixmonths of treatment with the Pain MedicineService, Kyro continues to do well.

FOR MORE INFORMATIONAngell Animal Medical Center-Boston’sPain Medicine Service is a focused clinic thatoffers treatment for companion animals withdiscomfort that negatively affects their qualityof life, regardless of their primary diagnosis.Many of our patients have complex medicalissues that complicate treatment for pain.Additionally, some types of pain are under-recognized and/or incompletely treated bytraditional medical care. The Pain MedicineService aims to serve these types of patientswhose owners wish to provide comprehensivecare to address quality of life concerns.Please visit www.mspca.org/painmedicineto learn more about the service.

To refer a patient to the Pain MedicineService at Angell-Boston please callNatasha Bureau at 617 541-5140 ore-mail painmedicine@mspca.org.

Figure 3: Within as little as three weeks of treatment,Kyro’s condition began improving.

Case Study

Figure 2: Kyro received electro-acupuncture as oneof the many parts of his complex treatment.