An 8-year-old intact male German shorthaired pointer was presented for a left pelvic limb lameness. Examination revealed a plantigrade stance with flexed digits in the left pelvic limb, and swelling of the left common calcanean tendon distally. Magnetic resonance imaging revealed a partial rupture of the left common calcanean tendon, involving rupture to the tendons of the biceps femoris, gracilis, and semitendinosus muscles. Surgical repair was performed using a modified 3-loop pulley suture. Postoperatively, the tarsus was immobilized with external coaptation. Destabilization of the external coaptation occurred over 9 weeks followed by physical rehabilitation and complete return to function at 10 months post-operative. This case report illustrates the utility of MRI as a diagnostic tool for evaluation of tendon pathology. MRI provided exceptional detail of the tendons that comprise the common calcaneal tendon and the anatomical relationships to surrounding structures which facilitated appropriate surgical correction.

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Objective: The objective of this study was to identify factors associated with leaving against medical advice (AMA) from inpatient substance use detoxification treatment. Methods: A retrospective study of 832 adult patients discharged AMA from an inpatient substance use detoxification unit. Variables from the following factors were included: demographics, substance type, medical history, psychiatric history, tobacco use, detoxification protocol, legal history, and reason for discharge AMA. The outcome variable was days until discharge AMA. Results: For demographics, only increased age was significantly associated with increased days before leaving AMA (B=0.002, SE=0.001, P< 0.01). For detoxification protocol, lorazepam was significantly associated with increased days before leaving AMA (B=0.06, SE=0.03, P< 0.05). For reasons for discharge AMA, only personal obligation was significantly associated with increased days before leaving AMA (B=0.05, SE=0.02, P< 0.01). Medical history, substance type, psychiatric history, tobacco use, and legal history were each not significantly associated with days before leaving AMA. Conclusions: This study identified factors associated with leaving AMA from substance use detoxification units. Clinicians may find it useful to spend more time counseling younger patients to encourage engagement in the entire spectrum of care, including detoxification completion. Patients who cited personal obligations as a reason for leaving AMA stayed more days than those who did not cite personal obligations as a reason for leaving AMA. Clinicians may thus find it useful to assess the urgency of the patient’s personal obligations before initiating detoxification, highlight ways addiction impacts each patient’s personal obligations, and identify available supports in the community to promote treatment completion.