Canine Arthritis Management

by Hannah Capon MA Vet MB MRCVS

The more I learn, the more I realise how much I don’t know

- Einstein

If a fellow vet student had foretold that in 16 years’ time I would be writing an editorial for Animal Therapy Magazine, with an opening line from Einstein professing how little I knew, I might have given up there and then. As a student of any discipline, you dream of the day you can consult with confidence, structure treatment plans with precision, and predict assured outcomes. However, through experience you realise that this is the Holy Grail; every case you see is unique, therapies are always developing, our understanding of different conditions advances.

When launching Canine Arthritis Management, I honestly thought that I would have a fighting chance of knowing one tiny element of veterinary medicine well, but what I realise is the more I learn and experience the more I realise there is so much more out there, and that goalpost will always be moving.

I recently wrote a slide for a lecture listing all the skills needed to identify, diagnose, and manage an arthritic dog appropriately. The list was immense and didn’t include owner psychology, financial philosophy, and crystal ball skills. This highlighted to me that as an industry we really should focus more attention on creating good relationships with fellow veterinarians, therapists and rehabilitators. It’s impossible to be everything to every one of our clients, and it is very humbling to acknowledge that.

The veterinary profession is often in the public spotlight, and our place in the public’s affection is a rollercoaster ride, which can be very tough. I personally have a huge amount of respect for my veterinary colleagues, as the level of knowledge and expertise expected, while also being a smiley friendly face stuck in an oxygendeprived, anal gland-scented shoe box of a room, is immense. The advances in veterinary medicine have meant that referral to specialists is already the norm and I feel this will continue to grow to encompass more and more disciplines. I remember being a new graduate trying to not only field medical and pet management advice, but also having to contend with complex behavioural issues. It was a dangerous minefield. Thankfully, times have changed and it is accepted that owners are referred to a behaviour specialist.

We are now seeing the same approach being applied to rehabilitation and the incorporation of complementary therapies such as physiotherapy, hydrotherapy and acupuncture into mainstream management of cases. These disciplines certainly did not feature on my syllabus 16 years ago. But thank goodness it didn’t as it could have been the “knowledge straw” that broke the student’s back. Already the universities are trying to equip veterinary students with everything they need to know although massive voids exist for financial and business planning, time management and mental health preservation.

I feel therapists should embrace and encourage this developing collaborative ethos and drive it forward. We should make the “crossover” for vets easier, explaining the concepts and evidence behind the proposed management of the case. Consider the language they use in reports, and whether it is accessible to others not conversant with their skill-base. We should set aside time to make personal contact, offer lunchtime learns and evening greets. However hard, the door should remain open and it should be checked frequently.

In my opinion, these collaborations are essential for us to make progress in managing these complex disease processes. The CAM team all appreciate this and thus work voluntarily to bring together specialists, experienced vets, rehabilitators, and other therapists, to grow a safe, reliable and supportive online resource for dog owners. We feel this should be available to all, from first-time owner to experienced dog handler, and not subject to financial constraints. We take inspiration from Arthritis Research UK and Arthritis Care which are well supported resources for human sufferers. Online information for patients is a mainstream approach for GPs; doctors also have time-restricted consults, defined skillsets and accept that retention of their one-on-one advice to their patients can be well below 50%. Through respected online resources they can instruct patients to self-educate and empower, knowing the content on that site is current and presented in an appealing fashion. But back to the therapist. Very few of us therapists have the pleasure of working in a rehab facility, orthopaedic or pain referral clinic, where many different skills are under one roof allowing easy communication and simple collaboration. If only a programming whizzkid would see this as a potential niche market to hone their skills. Most of us work alone, write our reports alone and have successes and failures alone. It is a tough profession and only now, working within it, do I appreciate that. I have definitely found that I am more likely to get involved emotionally in the cases that I see when working outside the vet clinic with its supported boundaries. Which highlights another neglected area of the management of long-term debilitating disease like arthritis – emotional support for the owner. I have found that this is an essential part of service provision, as it improves owner compliance and motivation, and thus results are better. Sadly, little scientific literature exists on the power of the caregiver placebo effect in the dog–owner relationship, but it is a widely recognised as being powerful in the parent–child relationship. It has to be accounted for when performing strict trials of drug efficacy, and neglecting it is a common flaw in clinical trials. But post these trials and in the real world should we be ignoring it and trying to negate it? Or should we be optimising it, as placebo actually implies that a positive result is experienced in the patient even though the treatment given is known to not effective? Through empowerment, encouragement and emotional support we could offer additional improvement to our clients’ pet’s condition. An interesting and dangerous topic, but surely another effective pathway to be used in the multimodal approach that should be considered when managing an individual case.

No matter what the job title, animal therapists should be celebrated. I never thought that I would find a career path as challenging as working long nightshifts in a busy emergency veterinary hospital, but I have. The skills and determination required to be a self-employed therapist of any kind are hard to beat.