Shankley B
Author:
Dr Dave Tittle | BVetMed | CertVA | MRCVS | GP Certificate in Western Veterinary Acupuncture and Chronic Pain Management | RCVS Advanced Practitioner Veterinary Anaesthesia
Contact:
To correspond with Dr Tittle please e-mail us at [email protected]
Case History
- Name: Shankley B
- Age: 11 years 2 months
- Sex: ME
- Species: Dog
- Breed: Labrador
- Lifestyle: Sedentary
- A brief history of the animal’s family history:
Owned since puppy; sedentary lifestyle. Morbidly obese. Has to climb steps to enter the house. - Interventions:
Needs to be able to access 4×4 to enable transportation; needs to be able to climb steps to get into the house. Doesn’t exercise more than the gait of walk. RH chronic cruciate injury with associated OA.
- A brief history of the problem which animal is being treated for:
Started firocoxib by referring vet approx. five years earlier for left elbow OA signs. Coped well, despite weight gain. Seen in Pain Clinic as an acute referral for rapid deterioration in mobility associated with considerable pain on manipulation of right shoulder and elbow – subsequent swelling of distal limb RF. Started gabapentin, methadone Q4hrs, ketamine infusion, paracetamol and continued firocoxib. Given co-amoxiclav IV for suspected septic osteoarthritis. CT scan was suggestive of this. Lidocaine infusion added to try and rescue analgesic requirements; subsequently weaned from methadone onto tramadol. Continued six weeks of co-amoxiclav. Discharged to the owner after 7d hospitalisation on firocoxib SID, paracetamol BID, tramadol QID, gabapentin TID, with physiotherapy/mobility exercises. Not currently a hydrotherapy candidate due to issues mobilising; acupuncture contraindicated with septic focus.At follow up consults, owners keen to maintain QOL, with minimal drug side effects. Found that tramadol makes him markedly lethargic alongside gabapentin, which they decreased to BID admin vs TID, due to this. After discussion, suggested considering adding ElleVance to his cocktail, on the understanding that initially they may expect some somnolence especially with concurrent gabapentin admin. Also, indicate that need to maintain gabapentin at TID dosing.
Examination findings
General observations/Assessment:
Following his marked and acute septic flare, his analgesic requirements were controlled. Still, it was evident he required something else to maintain this requirement and also provide an acceptable QOL moving forwards. He was bright and happy, with a good appetite. He was obese (BCS 5/5).
Tests results:
Chem 17 blood tests (including WBC’s) and CRP had returned to normal parameters following hospitalisation event six weeks earlier. T4/TSH was normal.
Neurological testing :
Occasionally knuckles RF at walking; mildly delayed proprioception this limb.
Pain assessment:
| Exam | Hudson Pain Score |
| Initial | 1.5 |
| Six weeks after | 1 |
Gait Assessment:
Initially, he was recumbent and required slinging to mobilise. Following acute treatment, he was active and mobile – 3/10 lame RH, 2/10 LF, 1/10 LH/RF. At six weeks following initiation of ElleVance, this has improved to 2/10 RH, 2/10 LF, 1/10 LH/RF. He is bright in himself, more lively and interactive (although he has gained 1kg!)
Supportive media:
(click image to enlarge)
Treatment
Current Medication
| Active | Proprietary name | Dose |
| Firocoxib | Previcox | 227mg SID |
| Paracetamol | Paracetamol | 500mg BID |
| Gabapentin | Gabapentin | 200mg BID/TID |
Complementary therapies:
| Active | Proprietary name | Dose |
| CBD/CBDA/Terpenes | ElleVance | 50mg BID |
Special instructions:
Acupuncture and hydrotherapy were planned to be offered once the septic focus was resolved. Unfortunately, COVID-19 restrictions have precluded this to date. Dietary restriction was strongly recommended and supported remotely during COVID-19 restrictions. This has not been successful to date.
Owner education:
Owners are working on weight loss and increasing exercise as he is able. Counselled to monitor for any increased somnolence, when first started ElleVance, especially as also receiving gabapentin.
Measurable outcomes and Conclusion
Outcome:
Improved mobility and quality of life. Improved pain and gait scores.
Remaining problems and goals:
Obesity, obesity, obesity.
Conclusion/ Discussion:
Currently stable and has markedly improved quality of life. Since started ElleVance, have managed to decrease gabapentin to 200mg BID (previously TID) whilst maintaining other drug regimes.
