Vet Education的动态

Transcript

Hi everyone. It's Phillip here from Vet Education, the end of day one of the world's Small Animal Vet Association Conference 2024 here in Suzhou in China. This is the first of I think two or three short episodes this evening, partly because I have attended so many amazing lectures today and. Big kudos to the organisers who have managed to get some amazing speakers here and a huge shout out to the incredible speakers. Wanna talk 1st about a lecture that I went to this morning. It was delivered by Doctor Leon Warn who's a specialist anesthetist and many of our viewers of that education will recognise the name Doctor Leon Warn because he's spoken a number of times that are online veterinary conference. We really like Leon because he's very down to earth. He's very practical in the in the recommendations and advice that he gives in his lectures. Today he spoke on pain management on in osteoarthritis. And I guess he kicked off by pointing out that osteoarthritis is a chronic disease. It starts with animals are very, very young, and it's a lifelong disease. Now, as veterinarians, you know, I think we're quite good at. Managing pain when animals have acute flare ups of osteoarthritic pain. But Doctor Warner really reminded us today that this is a progressive disease that starts actually when animals are very, very young and slowly gets worse as their life goes on. And it's come up with really, I guess, a review of. 3 stages of medications that we might want to give to our patients with osteoarthritis and throughout the course of their disease. First and foremost, it's really important to stage the patients. Disease process and there are a number of staging tools that are available for use in dogs. We grade the dog, grade the joint and then we're able to stage the animal as far as the severity of its disease is concerned. Now as far as analgesic options are for our patients really we've left with first line analgesics, second line analgesics and then third line analgesics. Enough first line analgesics really form into two categories are non steroidal anti-inflammatory drugs or anti nerve growth factor monoclonal antibody agents. You can't use them both together because there is some thought that the combination of non steroidal's as well as these. Anti nerve growth factor monoclonal antibodies might accelerate the progression of disease. So we're going to use either or and these medications, you know particularly non steroidal anti-inflammatory drugs veterinarians world over are very familiar with. They can be used for a long period of time with relative safety. They're reasonably efficacious for my guess, mild to moderate disease when it comes to. Osteoarthrosis, but there will be a time where we need to add in some more medications in addition to the non steroidal anti-inflammatory drugs that we might be using and these second line analgesics really. Are about. Multimodal analgesia rather than just providing anti-inflammatory medication for our patient or about dealing with things like nerve wind up that can occur. And I'm I guess the medications that we have available to us, depending on where you are in the world are cannabidiol is a wonderful drug for chronic pain management in dogs. So that's one option we have, Amantadine is another and you can use that either on its own or in combination with gabapentin. So the combination of say a non steroidal anti-inflammatory drug or the anti nerve growth factor monoclonal antibody with Amantadine and gabapentin can provide really. You know, good analgesia for those patients whose osteoarthritis is. Increasing in its severity and is leading to more and more debilitation in the patient. When your patients become markedly unwell and are suffering from significant loss of quality of life. We do have some third line analgesic options available to us and you know, we can use paracetamol as an additional analgesic medication. It's very inexpensive. It's relatively safe in dogs. It's associated with very few side effects in dogs. Obviously, this is not something that you use. Cats, but in dogs we certainly can use paracetamol or acetaminophen depending on where you're from. You can use ketamine either in a patient as an outpatient where you have the patient visit your clinic perhaps on a weekly basis and maybe a fortnightly basis, then out to a monthly basis for intramuscular or subcutaneous injections. Or as Doctor Warren pointed out, we can have like a ketamine vacation or pain vacation for the patient where the patient might stay in your hospital for 12/24, even up to 4248 hours or so, where they receive about 5 to 10 micrograms per kilo per minute. Off ketamine as a continuous infusion along with other things like, uh, warmth therapy, massage, acupuncture, whole bunch of other things that you might be able to provide for your patient when it's in hospital. So this is a really interesting thing. Ketamine is thought to actually physically change the nosey scepter to reduce. No susceptive stimulation to make it less excited by. The painful stimulus that is occurring and the cytokines that are involved in the inflammatory response in the generative joint disease and osteoarthritis. So and you know, the improvement you might get from ketamine can be actually pretty good in some but not all patients. So it's a treatment that is worthwhile considering. The other drug doctor Ward mentioned was amitriptyline was the tricyclic antidepressant medication. And this medication has been thought to alter the brain responsiveness to the no susceptive stimulation and spinal cord transmission of pain from peripheral nerves. So the combination you could use potentially ketamine and paracetamol and amitriptyline. One of the other things that Doctor Wong did mention as well was the use of lidocaine continuous infusions along with the ketamine when animals might be in your clinic for their pain. Vacation. So I think that's a really nice way of thinking about analgesia in patients with this chronic oftentimes debilitating disease as it especially as it progresses as animals get a little bit older. So those are my top takeaways from Doctor Warrens lecture. Huge thank you to Doctor Leon Won for the lecture. And again, as I said before, there was SAVA organizing committee here in Suzhou who put the program together really well done for selecting such an outstanding lecturer. More for me in a little bit. I'll talk about it one of the other lectures that I saw today. Thanks everyone and talk to you soon.