Ebook Hospice and palliative care for companion animals - Principles and practice (2/E): Part 2

Part 2 book "Hospice and palliative care for companion animals - Principles and practice" includes content: Pharmacology interventions for symptom management; physical medicine and rehabilitation for hospice and palliative care patients; integrative medicine in animal hospice and palliative care; nursing care for seriously iii animals - art and techniques; comfort care during active dying; euthanasia in animal end of life care;.... and other contents.
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Ebook Hospice and palliative care for companion animals - Principles and practice (2/E): Part 2 193 16 Musculoskeletal Disorders Tamara Shearer, MS, DVM, CCRP, CVPP, CVA, MSTCVM Musculoskeletal disorders involve the The following are a few of the more common i ­ nteraction between the body’s muscles, bones, musculoskeletal problems seen in hospice and ligaments, tendons, fascia, and joints. These palliative care patients. are common comorbidities seen in hospice and palliative care patients. They result in such profound disability that drastic decisions have to be made because of decline in quality of ­Osteoarthritis life.  In 2011, musculoskeletal disorders were Description considered the second most common cause of death because of organ system change in adult Osteoarthritis (OA) is a common condition and juvenile dog patients, according to a retro- seen in patients enrolled in hospice and pallia- spective study of over 75 000 dogs that died tive care. Like other diseases where pain is a at  27  North American veterinary teaching symptom, the incidence of OA is probably h ­ ospitals (Fleming et al. 2011). However, in a under reported. It has been estimated that 20% pilot study (Shearer and Marchitelli  2015) of dogs suffer from osteoarthritis (Marcellin-­ musculoskeletal cause for euthanasia or death Little et al. 2014). A study of 100 client-­ wned o in dogs moved from second, as observed in the cats, equal to or older than 6 years of age, Flemming study, to eighth in frequency for a found a 61% incidence of OA in one joint and a practice offering physical medicine. Cats also 48% incidence of OA in more than one joint struggle with musculoskeletal disorders that (Slingerland et al. 2011). Osteoarthritis is often can affect quality of life, but documentation secondary in nature and may be the result of of  incidence is more difficult because of the genetic predisposition, past injury or overuse, nature of their behaviors. developmental changes, and inflammatory A special note: when fragile patients present processes. Conditions like osteochondrosis dis- for investigation of musculoskeletal condi- secans, angular limb deformities, past trauma, tions, practitioners should be mindful that and hip dysplasia are examples of problems an  aggressive examination may leave some that increase the risk of OA. individuals profoundly painful and even debil- The mechanism behind the development itated. A gentle approach is recommended. of  osteoarthritis is complex and has been Hospice and Palliative Care for Companion Animals: Principles and Practice, Second Edition. Edited by Amir Shanan, Jessica Pierce, and Tamara Shearer. © 2023 John Wiley & Sons, Inc. Published 2023 by John Wiley & Sons, Inc. Companion website: www.wiley.com/go/shanan/palliative 0005542958.INDD 193 02-28-2023 15:55:36 194 Musculoskeletal Disorders discussed extensively by Fox (2012) and others Depending on the individual, some patients (e.g. Henderson and Millis 2014). Simply put, with OA progress to develop profound lame- the cartilage undergoes a series of physiologi- ness and severe debilitation. They are reluc- cal changes that include decreased proteogly- tant to move or are incapable of moving. can concentration, increased water content, Examination findings may include painful collagen fibril disruption, and degradation of joints, joint effusion, joint inflammation, and macromolecules. Loss of articular cartilage is crepitus in the joint. A decrease in a joint’s exacerbated in areas bearing increased load. range of motion may result from pain or from As a result of these changes, sclerosis of the physical changes to various joint structures. subchondral bone, osteophytes, and synovitis Thickening of the joint capsule may be pre- develop, all of which can contribute to the sent. Atrophy of the affected limbs may be joint pain. seen with hypertrophy of the other limbs or  muscles used to compensate for the OA changes. Comorbidities seen with OA include, Trajectory/Prognosis ...