Dr. Sabrina Manley Recognized by JAVMA for Her Research with Canine Patients at Foster Hospital

One of the most common reasons dogs come to the emergency room is concern that they ate something they shouldn’t have, such as a toy, a piece of chocolate, or rat poison. Inducing emesis, or vomiting, to expel the foreign object or toxin, can be challenging for the veterinarian and stressful for the animal and owner.

In an effort to determine the most effective method of emesis and the most tolerable for dogs, Dr. Sabrina Manley, resident in Emergency Medicine & Critical Care (ECC) at Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University, conducted a research study with the help of the wider ECC team and colleagues across FHSA.

The team’s illuminating findings, detailed in the manuscript, “Intranasal and intravenous apomorphine outperform ropinirole ocular drops for induction of emesis in dogs within ten minutes: a randomized, controlled clinical trial,” were published in the March 2024 issue of the Journal of the American Veterinary Medical Association (JAVMA). The study recently received an honorable mention in the Outstanding JAVMA Resident Manuscript Award category, which will be announced at the 2025 AVMA Convention this summer in Washington, DC.

“We were honored that JAVMA accepted the manuscript, and even more, that they gave the manuscript an honorable mention,” says Manley. “The editors agreed that the findings could help the entire veterinary community and could be crucial for our patients moving forward. It’s motivating to continue to do clinical research and advance veterinary science.”

Her study compared delivery methods of apomorphine (APO), typically used in these situations to stimulate the vomiting reflex, against newly FDA-approved ropinirole eye drops. She evaluated four methods of administering APO: intravenous (IV) injection, subcutaneous (SC) injection, intranasal (IN), and topical transconjunctival (TC) (through eyedrops). The study measured the overall efficacy of each, including the success rate of emesis, and it is the first study to evaluate intranasal administration and the difficulty of performing each method.

“The goal is to find something fast and easy to administer,” explains Manley. “The intravenous works quickly, but there is a subset of dogs for whom it is hard to give an injection. For ropinirole, big dogs sometimes require numerous eyedrops, and after the first few eyedrops, some dogs catch on, and it can be difficult to finish the dose. We’re trying to find a route that is not scary and works fast.”

Intranasal, notably, is not painful for dogs and has been found to work well in people (for other reasons), but has not been studied previously in dogs.

“Every dog has a different personality type,” says Manley. “A lot of dogs tolerate intranasal more than a shot. The goal was to see if IN would help dogs who fear injections and how it compares to our routinely used methods.”

Manley collected data on 125 dogs that presented at FHSA over six months, with each method administered on 25 dogs.

“It’s the first large study I’ve done in my career,” says Manley. “The study involved almost everyone in the ER—students, assistants, doctors, support staff, nurses. The only reason I was successful in getting so many dogs in that period of time is that it was a team effort. It was the support staff that loved the study, wanted to help dogs, and helped collect data.”

Manley and team found that administering APO to induce vomiting within 10 minutes was most successful through IV injections (22 of 25 dogs), followed by IN (18 of 25 dogs), ropinirole eye drops (14 of 25), SC injections (6 of 25), and TC (4 of 25). Of successful emesis, IV was fastest, followed by IN. The most difficult to administer were IV and TC.

The manuscript concludes, “IN APO was a rapid, easy, and effective method of inducing emesis in dogs and should be considered when IV administration is not possible.”

In comparison, ropinirole eyedrops were well tolerated by the dogs, but not consistent in causing vomiting within 10 minutes. The paper also notes, “While IV apomorphine is effective, administration of these medications can be challenging, since physical restraint can trigger fear, anxiety, and stress in dogs in the hospital setting, potentially leading to staff or patient injury.”

These findings are of particular relevance to emergency and primary care practitioners who regularly treat dogs in these situations. JAVMA posted the study as open-access, so that any veterinarian can view the results. Manley presented an abstract of the study at the International Veterinary Emergency & Critical Care Society (IVECCS) conference in San Antonio in 2022.

“If giving medicine intranasally is as successful as the others, this could be a new route,” says Manley. “Especially for those dogs fearful of injection, this is a way of treating without scaring them. We can make their experience at the vet so much better.”

Two professors played a significant role and are co-authors of the study: Drs. Alexia Berg and Elizabeth Rozanski, assistant clinical professor and associate professor, respectively, in the Department of Clinical Sciences, are both on the ECC team at FHSA. Berg has been a mentor to Manley during her four years at Cummings School.