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Pain Management and Greyhounds
by Judy Kody
and Michael Tomasic, VMD DACVA
(Excerpt from Winter 2003-2004 issue of GCNM News)
Animals (people included) who lack the ability to sense or respond to pain are doomed to a short, pitiable existence. Pain sensation is a physiologic necessity. The types of pain we experience are classified in three categories: Type I, Type II and Type III.
Type I pain sends an alarm quickly to the brain, indicating actual or impending tissue damage that may be harmful to one's well-being. Appropriate response to the sounded alarm prevents or limits damage to the tissues. This response is triggered by very cold, very hot, or intense mechanical irritation. The fast-acting system of nerve pathways that carries the signals to the brain is precisely organized so that it is easy to recognize exactly where the pain is coming from.
Type II pain is transmitted by a separate system of nerves than those dedicated to Type I pain. These nerve fibers carry signals rather slowly, so the onset of Type II pain is slow. While this system responds to the stimuli described for Type I pain, it is also sensitive to chemical changes that occur in and around damaged skin, muscle, bone and organs. Type II pain is dull, often aching or burning, sometimes with a throbbing quality. The signals sent to the brain in these instances make the painful sensation diffuse and difficult to isolate to any one specific location. Type II pain usually follows Type I pain when there has been tissue damage. The persistent burning sensation that follows the initial sharp, piercing pain of a bee-sting is an example of Type II pain. This type of pain will persist until the damaged tissue heals. Its purpose seems to be one of encouraging immobility and rest to promote healing and to discourage further injury.
Pain sensation is carried from the tips of nerve fibers in the skin, connective tissues and organs to specific regions within the spinal cord. Here, the signals are processed and, if strong enough, are sent to higher centers in the brain. Under unusual conditions, such as actual damage to the nerve fibers which carry sensory information or in cases of long-standing pain signaling, these processing centers in the spinal cord and brain can change. The pain processing centers become altered and begin to generate pain signals to the brain without any external stimuli. Now, pain can be felt for no external reason at all, at which point the pain is classified as Type III. Type III pain is really a disease in itself. It is the most difficult of the types of pain to diagnose and effectively control.
With prolonged pain, changes occur within areas of the brain that control appetite, social responses and attentive behavior. The longer the pain persists, the more the brain is engaged with responding to it. Mood swings (common in sighthounds), lethargy and weight gain (common in terriers and retrievers) are often seen in dogs with chronically painful conditions such as osteoarthritis. The animal that has long-standing chronic pain (Type II pain, with or without Type I pain) is on a slippery slope. With inadequate, inappropriate or delayed treatment, the ability to manage this animal's pain becomes increasingly difficult as he slides into the abyss of Type III pain. In cases of extensive, severe Type III pain, destruction of the animal often becomes necessary for humane reasons.
Pain and associated responses with regard to a particular stimulus is unique for every living creature. It stands to reason that the optimal control of pain should be tailored to the individual; taking into consideration a balance of inherited, social and experiential factors.
After a Greyhound retires from racing, its destination is determined by its suitability as a pet. Serious injuries can significantly reduce a dog's prospects for an adoptive home due to the likelihood of long-term medical problems and their associated expense. Some people volunteer to take a retired racer with old injuries, not fully comprehending the needs of a dog that may have chronic pain. But without these saintly adopters, there would be a much greater number of Greyhounds being destroyed annually, due to the high occurrence of severe injuries.
Racers in Stacked Crates
It is safe to assume that most racing Greyhounds will suffer some type of injury during their careers as racers. From the rigors of training and racing to the repeated impact of jumping substantial distances out of crates and transport trucks, these dogs experience far more trauma than a typical canine. Most of the care and treatment active racers receive is administered by someone other than a veterinarian. Trainers attempt to diagnose and treat a large number of injuries without veterinary assistance. Due to limited finances at many kennels, the more severe injuries are dealt with in the most minimal fashion. This approach results in an animal that, if lucky enough to be adopted out, may need surgery or extensive therapy to counteract mediocre remedies used while at the racing kennel. Serious injuries that end a Greyhound's pursuit of the racing lure are often left unattended as it is financially unfeasible for most owners and trainers to invest money in veterinary care of a dog that can no longer support its expenses. Depending upon the severity of the injury, the Greyhound may be given to an adoption program for placement or euthanized.
The most common injuries racers will encounter are to the right hind leg, resulting from running counter-clockwise on the track, thus producing extreme stress on this area as they propel themselves through the curves. Hock injuries are particularly complex due to the intricate structure of this set of bones. Shoulder injuries are sustained when racers hit the sides of the starting box as they lunge from it or strike fences, rails or posts while running around the track. Tail injuries occur when doors of starting boxes are slammed shut in haste, without regard for positioning of the racer's tail. Muscles, ligaments, and tendons are constantly stressed, particularly when racing Greyhounds are improperly conditioned by their trainers. The concussion encountered by the musculoskeletal system each time a racer jumps from an upper level crate or transport truck is a significant shock for the body to absorb repeatedly during the course of each day.
Many of these injuries can produce chronic orthopedic problems, neurological problems, or both. Immediate resolution of the injury or disease process through medical or surgical management is the key to limiting the experienced pain. Determining the cause of pain is, therefore, very important. Making the diagnosis can be very difficult, even frustrating, but it is almost always worthwhile. X-rays, CT scanning (CAT scans), magnetic resonance imaging (MRI) and diagnostic ultrasonography can be very helpful. Clinical laboratory reports of blood serum chemistries and blood cell profiles are also important sources of information. A good physical examination of the patient is essential. In short, the more information that is available about the patient, the better.
While the best means of controlling pain is to eliminate its cause, it is not always possible to do so. There are no cures for chronic arthritis, nerve damage, diabetes, or renal failure. Even for those conditions where surgical or medical treatment is curative, the healing process is not instantaneous. Regardless of the disease or injury, pain management should be part of the therapeutic plan of action.
A pain management program is geared to break the cycle of pain. It may include anti-inflammatory agents, anti-convulsants, anti-depressants and/or narcotics, as well as more sophisticated and invasive techniques such as epidurals and regional nerve blocks. Regenerative Injection Therapy (RIT) can be used to help strengthen arthritically weakened joints, tendons, and ligaments. Injections directly into the affected joint and/or its supporting soft tissue structures stimulate a regenerative process that can strengthen the connective tissues (ligaments and tendons) and stabilize the joint. Injection of hyaluronic acid, an important component of joint fluid, into the joint to improve the lubricating qualities of the fluids in and around the joint surfaces, and the intramuscular injection of polysulfated aminoglycans, such as Adequan®, are other minimally invasive osteoarthritis treatments. Oral supplementation with glucosamine - the fundamental building block of polysulfated aminoglycans - can be very beneficial, as well; in fact, it is probably prudent for all older dogs to receive oral glucosamine (with or without chondroitin sulfate).
For many causes of pain, acupuncture - a minimally invasive, drug-free technique using fine, flexible needles - can stimulate and influence the nerve pathways involved in the pain signaling process. Additionally, techniques such as chiropractic manipulation, therapeutic ultrasound, various types of electro-therapy, or controlled physical therapy may be used to keep pain at manageable levels.
Adoption groups sometimes take on the burden of veterinary expenses for injured Greyhounds, but most often these expenses fall into the hands of the adopters. Potential adopters should always take into account the possibility of more frequent visits to the veterinarian when adopting a retired racer as opposed to other canines. (Greyhound Companions of New Mexico requires all adoption applicants to read the information on our website, www.gcnm.org, wherein it is stated that retired racers may require unusually frequent visits to the vet.)
It can take an enormous amount of patience and an equal amount of money to provide for a retired racer with old (or new) injuries; however, the rewards can be immeasurable. Greyhounds, especially the ones needing extra attention, can give humans a profound sense of fulfillment in watching the dog's improvement, both physical and psychological. The Greyhound's amazing capacity to demonstrate affection and appreciation can be incredibly gratifying to the adopter willing to take on the commitment of caring for a "special-needs" animal.
Dr. Michael Tomasic is a 1985 graduate of the University of Pennsylvania School of Veterinary Medicine. After two years as an associate in a central Pennsylvania mixed-animal practice, he returned to the University of Pennsylvania to complete specialty training in anesthesiology and critical care. Following his residency training, Dr. Tomasic began a three-year post-doctoral fellowship in cellular pharmacology and electrophysiology through the University of Pennsylvania School of Medicine and the Hospital of the University of Pennsylvania. As a faculty member of the Department of Clinical Studies at the large animal facility (New Bolton Center) of the veterinary school, he supervised the anesthetic management and post-operative care of animals referred for surgical and diagnostic procedures; supervised the operation of the pharmacy and the clinical diagnostic laboratory; and was thoroughly involved in the education and training of students and residents in the practice of anesthesiology. Dr. Tomasic started a formal chronic pain management service at the New Bolton Center in 1997, and began treating performance horses and small animals on a regular basis. He became certified in veterinary acupuncture by the International Veterinary Acupuncture Society in 1998.
In 2001, Dr. Tomasic moved to Santa Fe, New Mexico, to establish the first veterinary referral practice for pain management in the nation: Veterinary Pain Management. Treating primarily dogs and horses, Dr. Tomasic's aim is to develop pain management protocols specific to individual patient's needs, rather than simply providing symptomatic relief. He was appointed to the Board of Advisors of the American Academy of Pain Management, the largest multi-disciplinary organization of pain practitioners, in May of 2003, and was instrumental in the establishment of the International Academy of Veterinary Pain Management (September 2003).
Although Dr. Tomasic is located in Santa Fe, he sees patients in Albuquerque on Wednesdays at the Albuquerque Emergency Animal Clinic on Prospect, N.E. To obtain an appointment with Dr. Tomasic, a referral from your current veterinarian will be necessary.
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