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Why are we not treating it? - Kathryn Cowley

  • 16/03/2020 14:58:00
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Why are we not treating it? - Kathryn Cowley

It’s thought that at least 80% of dogs over the age of 8 have arthritis. But if you reflect on how many dogs in this age bracket you’ve seen in the last week you’ll probably realises that far fewer than 80% of them are receiving treatment. Arthritis is a common, painful and even debilitating disease. Lack of treatment means we are even euthanizing some patients after months of years of pain results in the dog eventually going “off their legs”. While the owners may see this as a sudden event, too often, if you look closely, you can see this is not the case - they have a huge amount of muscle loss, poor coat quality and maybe even saliva stained hair over the painful joints - all these things are indicators of arthritis and chronic pain. In fact, arthritis is a leading cause of premature euthanasia of dogs in the UK.

While arthritis may not at the outset seem like a particularly interesting or complex disease to treat, and certainly not one which is afforded much teaching time at university or even during our CPD, it is clear we need to be doing more. 

But why aren’t we? 

One of the major issues is likely a lack of understanding on the part of dog owners - signs of chronic pain like slowing down, stiffness and becoming “grumpy in their old age” are often dismissed as part of the normal ageing process and not attributed to pain. An owner bringing in their seemingly healthy 9 year old Labrador for a booster vaccine is not always going to be receptive to being told they have arthritis. Take a few years off the age of that Labrador presenting for a booster vaccine and try telling a 5 year old dog owner their dog has arthritis signs and you’re really facing a challenge! Arthritis is an old age disease in many minds, and old age means eventually saying goodbye to their dog. Being told they have a disease, any disease, can almost be the first step in a grieving process. 

If you do have an owner that’s recognised the signs of pain then half the battle is won. They have come in wanting you to take action. But time constraints in a consultation can be a real issue when it comes to discussing a disease which has so many influencing factors. It’s impossible to discuss all the management options in a 10 or 15 minute consultation and so we end up telling owners to give our chosen non-steroidal medication, walk their dog less and revisit in a month. While this is better than nothing, it’s certainly not enough. We should ideally be discussing exercise in more detail, advising on diet and weight management, physical therapies, and home adaptations  and ensuring our owners can measure response to treatment as objectively as possible so we know what is or isn’t working for a particular patient. Taking the time to give this more thorough advice may even help us to combat the wealth of misinformation from “doctor google”.     

You might think that giving all this extra information sounds great, if only you had the time to do it! Don’t be afraid of asking owners to revisit with yourself or with a nurse to give you that extra time. Also consider having a bank handouts or reliable online resources, you can direct them to Canine Arthritis Management  - owners may remember as little as 30% of what they are told in a consultation so these resources can be invaluable to help them retain the information they need as well as preserving you some precious consultation time.  

Another common frustration you can face is an owners reluctance to treat their dog on grounds of costs, or for fear of long term side effects associated with medication. The latter can be especially hard to understand sometimes when you give owners long term medications for many other diseases and side effects would never even come into question! We can potentially thank “Dr Goodle” again for this scare mongering around the use of analgesics, with NSAIDs in particular falling victim of this! Perhaps we also need to be cautious about our wording around the need for monitoring blood tests - we are not just looking for side effects but also for early indicators of the development of concurrent disease, especially in older pets. 

So arthritis is a multi-factorial disease which should have a multimodal approach to management and that has multiple reasons why that management isn’t happening! Maybe not the simple disease it first seems!

Written by Kathryn Cowley from Canine Arthritis Management

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