Navigating the Nuances of Hedgehog Analgesia

Discover methods to manage hedgehog discomfort as we chat with Dr. Grayson Doss and Macy Peterson. Their novel research on hydromorphone and methadone in this species reveals both promising and cautionary tales. As we unpack their study's implications, learn why every dose matters in the nuanced world of zoological companion animal medicine and surgery and gain insights into how a hedgehog's size doesn't diminish the complexity of its treatment.

JAVMA article: https://doi.org/10.2460/javma.23.11.0630

AJVR article: https://doi.org/10.2460/ajvr.23.12.0276

INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ?

JAVMA ® : https://avma.org/JAVMAAuthors

AJVR ® : https://avma.org/AJVRAuthors

FOLLOW US:

JAVMA ® :

Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook

Instagram: JAVMA (@avma_javma) • Instagram photos and videos

Twitter: JAVMA (@AVMAJAVMA) / Twitter

AJVR ® :

Facebook: American Journal of Veterinary Research - AJVR | Facebook

Instagram: AJVR (@ajvroa) • Instagram photos and videos

Twitter: AJVR (@AJVROA) / Twitter

JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

Transcript

Speaker 1: 0:00

You're listening to Veterinary Vertex, a podcast of the ABMA journals. In this episode we chat about HydroMorphone and Hedgehogs with our guests Grayson Doss and Macy Peterson.

Speaker 2: 0:17

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Grayson and Macy joining us. Grayson and Macy, thank you so much for taking time out of your super busy schedules to be here with us today.

Speaker 3: 0:31

I'm happy to be here. Thanks for having us.

Speaker 1: 0:34

All right, let's dive into the fascinating research being performed in Zoological Companion Animal Analgesia. Grayson, your JAVMA article discusses how a subcutaneous HydroMorphone provides anti-nose deception in four-toed hedgehogs. Please share with our listeners the background on this study.

Speaker 3: 0:52

Sure, what we wanted to do is take an opioid that was commonly used in veterinary medicine for analgesia and study it in pet hedgehogs, because there wasn't very much out there at all on pain control or analgesia in general. In that species, hydromorphone seemed like a great drug to look at because it's so widely available currently.

Speaker 1: 1:24

I know too in small animal medicine with dogs and cats. Hydromorphone can typically be a little bit less expensive too than other options such as methadone. So definitely something interesting to study in the species.

Speaker 3: 1:35

Absolutely. It seemed like a no-brainer Because of the potential for it to last longer than some of the other opioids that are available. It was one that we were interested in and trying out for sure.

Speaker 1: 1:51

The supplemental videos that you guys have, too as a part of this manuscript, and your methadone one and AJVR have been very popular in social media too. It's a great way for people to see some of the potential effects they may see with these and therapeutics, so thank you for submitting those as well.

Speaker 3: 2:06

Absolutely.

Speaker 1: 2:08

So, Grayson and Macy, what were some of the pivotal findings from the study?

Speaker 3: 2:13

Yeah. So one of the interesting things we found was that the HydroMorphone provided several hours of analgesia, although it wasn't quite as long as we were expecting, which was something that we had gone into the study off the tails of research with buprenorphine in hedgehogs. We were hoping that it would stick around longer than other species, but we were surprised that it was more comparable to what we see in companion animal, like dogs or cats, as far as length of duration. So that was, I guess, a pivotal finding. The other thing we found, and that Macy found, was just the adverse effects, which we also, I guess, expected. But coming off of buprenorphine, which we saw very little as far as classic opioid adverse effects, it was a bit surprising and I would argue that's a pretty pivotal finding.

Speaker 4: 3:21

Yeah, kind of going off of that kind of seeing, even with our multiple dose study for the HydroMorphone, of having the decreased food intake within the first 24 hours and then overall with like the six days, was kind of surprising to us, especially because we didn't see necessarily the same exact findings with our single dose. Even though it was a small decrease of food intake for the first 24, for a single dose it wasn't statistically significant compared to the multiple dose, which was pretty significant. And it was interesting because, like Dr Doss had mentioned, it wasn't seen in our previous buprenorphine study or with our previous methadone study either.

Speaker 3: 4:03

Go off what Macy said in that the food intake was something that we wanted to look at pretty closely and I agree with Macy it was surprising that it did drop, although when you look at the level of adverse effects that we saw with the higher dose of HydroMorphone, even with a single dose, I guess it wasn't entirely surprising because we were giving him three doses within the same day, within a short timeframe, and so definitely has some clinical relevance on how you use that drug when you're kind of approaching patients.

Speaker 2: 4:42

That's a great point, Grayson. What sparked your research interest in hedgehog analgesia? Was it your own hedgehog or a specific case that you recall?

Speaker 3: 4:53

Sure, we see a good number of hedgehogs where I work at the University of Wisconsin. There wasn't a whole lot in the literature. It's one of the species, even though they're pretty common pets. I would say they've even gotten even more popular over the past 10 to 15 years. Very little people are doing any sort of clinical research with them. It can be very frustrating trying to come up with therapeutic plans, particularly in hedgehogs. I saw that as an opportunity to approach the challenge of developing a way to do clinical research with hedgehogs. The first thing in my mind that was to tackle that is arguably probably the top three most important things would be analgesia. That was the thought process behind it is that as vets we should be able to control pain appropriately or do our best to do it. It was tough to argue that we were doing a great job in hedgehogs.

Speaker 2: 6:07

Yeah, that's fascinating. People outside of the veterinary profession don't realize just how many species we need to see. They think dogs, cats, horses, cows. Here we are talking about four-toed hedgehogs and energies specifically. Well done to dig into that. You both talked a little bit about your pivotal findings. I think you used the word interesting and other things. But, macy, was there anything in this study that you're like, wow, I absolutely didn't expect that. We need to look into that a little bit more.

Speaker 4: 6:38

Yeah, I think what we alluded to a little bit before was the duration of antinose deception that we did find with the hydromorphone Although it was, like Dr Dawson mentioned, was pretty comparable to what other species are, such as cats. We were expecting to see a little bit more of an increase in duration, as we'd seen with the buprenorphine study that had been performed previously. But I think, in terms of other surprising things also just mentioning the adverse effects again, although they are common and they were pretty transient within less than three hours, I think they're still again kind of useful to know and to be able to see and observe these sort of chewing of the mandibles, as well as kind of paw raising and things like that, which we don't necessarily see in other species, and so it was interesting to be able to see what kind of adverse quote unquote adverse side effects are kind of present in these species as well, compared to other species like cats or ferrets and things like that.

Speaker 2: 7:45

Yeah, that's fascinating. You seem to both agree on what the quite surprising findings. Again based on your previous experience, grace, do you have any insight on these two most interesting findings? Why the hedgehog is like that?

Speaker 3: 7:58

Yeah, I think we were looking at hydromorphone through the lens of what we found with buprenorphine is that it was lasting 36, 48 hours after a single dose just regular buprenorphine and so, which is longer than any other species. And so we went into it thinking that hydromorphone would be similar also methadone and so finding out that the duration of action was more comparable to very different species was definitely unexpected, and a lot of it has to do probably with drug composition and it could be way more complex than that's way over my head. But it was definitely unexpected and surprising. And the other thing that I found surprising that Macy had mentioned where the adverse effects, particularly for me, would have been the vocalization, and so it's uncommon to hear hedgehogs vocalize in that way.

Speaker 3: 8:58

They are a very vocal species. They make a lot of hissing noises and snorting and like clucking. Sometimes it's just as a defensive. But as far as this kind of high pitched vocalizing that we saw with opioid administration, that is initially a little unsettling but you kind of get used to it. It's not something outside the realm of impossibility. If you think about dogs that get opioids, a lot of them will sometimes vocalize and so. But to hear a hedgehog do it when they're normally pretty quiet, when they're not disturbed, was a little bit unusual, but it did kind of fit what we would expect to see with opioids in other species.

Speaker 2: 9:39

Yeah, it's definitely an eerie sound when you hear that. You know like oh, somebody found an opioid in that ward. When might a hedgehog make that noise? The opioid howl.

Speaker 3: 9:50

Well, they can make several different vocalizations. There's some that they make during, like courtship periods, when there's they're talking to each other different sexes. And then there's some noises that they make only when talking to offspring, like during raising young. There's some that they make when they're distressed and it doesn't fit the time. The vocalizations I've heard when they're distressed. Necessarily, I have heard that from time to time, but it's almost kind of like its own, unique I would. It was hard for me to classify it into what it's similar to, but it definitely is unique to the vocalizations I've heard before.

Speaker 2: 10:28

So fascinating Thank you.

Speaker 1: 10:32

Yeah, hedgehogs are very cool, so hopefully we have some zoological companion animal lovers listening to this, or just some very curious veterinarians to. It's amazing how my species we can work with.

Speaker 3: 10:42

Absolutely.

Speaker 1: 10:43

It's a little bit off script, but since you brought up the Bifidorphine study and we mentioned the methadone one, between these three different opioids, are there any big take homes that you have for our listeners when they're trying to choose analgesia for the species?

Speaker 3: 10:56

Sure, yeah, I mean, I think, what we found with buprenorphine, which was published in Javim a couple of years ago it lasted forever after just regular buprenorphine hydrochloride, not extended release or SR or anything like that, and it had very little adverse effects, and so I tend to reach for that very commonly for analgesia.

Speaker 3: 11:21

However, as we know from other species, buprenorphine has its limitations.

Speaker 3: 11:25

When it comes to moderate or severe level of pain, it may not be the best choice for most species, and so that is one of the reasons why we looked at more of these mu-opioid agonists with hydromorphone, with methadone, which has other benefits as well, like on anti-imetic benefits, and so they're just much shorter acting, and so and you also have these adverse effects that don't last very long.

Speaker 3: 11:54

Comparatively, they last similar to what their duration of action would be as far as analgesia. So I'm more likely to reach for these quote-unquote stronger opioid choices, these mu-agonists, when the level of pain control needs to be a bit higher. So if you're doing more invasive things immediately post-op or pre-op versus, buprenorphine, I feel like, is a bit more versatile for pain that may not be at that level, and so just because it lasts so long, it's great because you don't have to inject them very frequently. So I think they both these drugs have their own place in head-chog medicine surgery and it's nice to have a few more options, I think, on the table. But that's kind of how I think of it and approach it.

Speaker 1: 12:44

Yeah, thank you. I think they'll be really important for our listeners. So I appreciate you sharing that with us. And then, for those of you just joining us, we're discussing hydrogen morphone and hedgehogs with Grayson and Macy Grayson. How did your advanced training prepare you to write this manuscript?

Speaker 3: 13:00

Well, I think I was able to have the time to write during a little bit during my residency and so that I had mentors that were kind of teaching me I had mentors before that when I was in vet school and during my internship kind of guide me on scientific writing. But just being able to do a bit more and having a bit more time during my residency to focus on that. That. I think the mentorship on how to really approach writing a scientific manuscript and just the repeated practice helped, Because it takes a little while to learn and it's not something that most people can just run right in and write a really solid manuscript on their first go. So it takes me many drafts to do. That's just how I handle it. But the mentors helped me kind of craft my writing style and kind of get it to where it wasn't. I wasn't writing novellas.

Speaker 1: 14:06

Macy and I were talking a little bit about mentorship before everyone else jumped on, and I was definitely in her shoes, actually at the same stage of my veterinary career when I wrote my first manuscript. So, macy, how has your experience as a veterinary student at UW helped you to prepare to write this manuscript?

Speaker 4: 14:23

Yeah, I think Dr Doss has played such a really crucial role in this as well, with helping me kind of learn how to write scientifically a little bit more and I had previous research experience in undergrad. However, the level in which that is compared to veterinary manuscripts is a different kind of change. So being able to talk with him and discuss how things can be set up, as well as kind of figuring out how to write my own way, is really important and kind of figuring out really honing in on what's important and kind of getting our point across for what we did in our research and kind of explaining what those details are and being able to extrapolate what our findings are without crossing any lines or borders or anything like that. So I think he's been a really great help and being able to help me be able to hone in on that and kind of continue to work on it and prove my writing overall.

Speaker 1: 15:20

Excellent. Love to hear that Now. This next set of questions is really important for our listeners. Trace in what is one piece of information the veterinarian should know before discussing a hydromorphone for pain control and hedgehogs with the client.

Speaker 3: 15:35

Sure, I think I see it mostly as something that's useful perioperatively. I think one thing that clients could see, depending on when the hedgehog goes home, is you might see this kind of trail over of adverse effects. Maybe they're a bit more out of it or maybe there's more vocalization than you would expect, but you might see a decrease in food intake also. So monitoring for that is something that seems to be common with opioid administration and hedgehogs. So that's something to think about for clients to at least be aware of if they go in for a procedure.

Speaker 1: 16:19

Thank you, and Grayson and Macy. What's one thing clients should consider around hydromorphone use for pain control and their hedgehogs?

Speaker 4: 16:28

Yeah, I think again it's kind of just mentioning what Dr Doss talked about is really watching out for those adverse effects, those hyperactivity vocalizations, and monitoring how long that lasts for Typically because hydromorphone we found that it lasts, depending on the dose, either between four to six hours less than that potentially and making sure that there's other adverse that are continuing on to either reevaluate with a veterinarian and things like that, in case there's something else that's more sinister underlying. Especially since the study had been done in healthy hedgehogs, we're unsure how buprenorphine really does affect some of these more sick animals, and so being able to monitor other adverse signs at home is really important for us to continue on to help really monitor and see how this drug works in all of the hedgehogs, both healthy and unhealthy.

Speaker 3: 17:25

Yeah, I would agree with that. I think Macy brings up a good point that this was a healthy population study and so it wasn't a clinical trial study where we're looking at it in debilitated hedgehogs, which is most of what we're going to see or administer these hydromorphone to in a clinical setting, and so we're not really sure how much more dramatic decreases in food intake or these adverse behavioral effects would last in an animal that may have decreased in a tibatic function or a renal function, and so it's just something to be mindful of as a clinician.

Speaker 2: 18:07

Really really important clinical data for an alternate species. Really, thank you both again and Macy, congratulations. It's never. Vet school alone is hard enough, but to get a manuscript published while you're in veterinary school is really amazing. Sarah and I want to take the opportunity to promote our journal awards, the nominations for Jabman Age of VR. We have student, intern and resident awards. We give out two awards per category, per Jabman Age of VR, and nominations close March 15. So get your nominations in everybody and as we come closing a little bit, we'd like to ask you some fun personal questions. So this one kind of dates most people. But, macy, what is the first concert you attended?

Speaker 4: 18:52

The first concert I ever attended was actually at Summer Fast, so it was kind of a concert of concerts, but the first big person that I went to go see was actually Jason Derulo.

Speaker 2: 19:03

Oh, wow, that's awesome. Grace, I will ask you something a little bit different. What is the oldest or the most interesting item on your desk drawer?

Speaker 3: 19:14

Wow, I have lots of interesting things in my desk drawer. Let's see the oldest. I think I actually have some floppy disks in there, which is going to date me for sure.

Speaker 2: 19:27

We like to play have you seen this before? With Sarah. Sarah's out of veterinary school by a couple of years, and there's many of us at the AVMA that are much older. So we're like, hey, have you seen? This Loppy disk is one of them.

Speaker 4: 19:39

We used to use it in our high school.

Speaker 3: 19:43

One thing I always have and I'm a strong component for is for ZooVets is just a good, solid headlamp. It's amazing how it really you never really know where you're going to catch yourself and need both hands to get in there. So headlamp, always have headlamp with me.

Speaker 2: 20:03

I would say the same as two for an equine vet.

Speaker 4: 20:07

Makes sense.

Speaker 2: 20:07

To get some awkward positions.

Speaker 3: 20:10

For sure.

Speaker 1: 20:12

Very nice Good advice, Macy. I went to summer fest many years ago and I think it was Luke Bryant, so I think I was in college. It's a very familiar one venue. But just thank you both again for being here today and for submitting your manuscripts to you to Java and AJVR. We really appreciate your time and sharing your knowledge with our listeners.

Speaker 3: 20:32

Thank you for having me, it's been great to talk.

Speaker 1: 20:36

To our listeners. You can read Grayson and Macy's article in print, java or using your favorite search engine. I'm Sarah Wright with Lisa4DA. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on the sample podcast or whatever platform you listen to.