Re: Pain relief for very painful horse

Kerry Isherwood

"....use of Fentanyl patches which were carefully monitored by Dr., and subsequently tapered.
     Yes, this is a narcotic, but does Dr. Kellon or the group object to the use of this drug?   When nothing else is appropriate, relief of intransigent pain is sometimes of supreme importance......"


I cannot agree more with this last statement.  Pain management is a huge topic in small animal medicine to the point wherein the advances in large animal seems paltry in comparison.  I worked with Dr. Muir (a veterinary anesthesiologist and "pain specialist", shall we say) at the Animal Medical Center in NYC and, as vet techs, we were taught to identify, measure and treat pain for various pre- and post-operative surgeries; aggressively manage known painful conditions or post-op surgeries in the ICU; and generally do our damnedest to prevent the dreaded state of wind-up pain whereby an animal reaches an exaggerated or extrapolated level of excruciating and almost untreatable pain due to poor prevention (ongoing underdosing of pain control measures), inappropriate drug choice, or in emergent cases, the impossibility of prevention (ie, trauma cases) that present in your ER.  Some animals would have to achieve near-coma status via analgesics/etc bordering on ventilator-dependence in order to break the vicious wind up pain cycle. 

Having lived that professional lifestyle for many years, I feel Im at a huge disadvantage as a horse owner that I cannot expect the same depth of pain management & treatment if/when my horse(s) will need it, that my dogs & cats & even my child, would have available to them if ever in need.  This is not meant to be a critique, but merely a lament of the frustrations of equine medicine.  Perhaps I've even said too much.

Kerry, LVT in NY
Sept 2014

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