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

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.