Christel Caderius van Veen graduated from Bristol Vet School in 2002 and is still in her first job! Her interest in arthritis was sparked early in her career when a fellow delegate on the GPCert(SAP) course mentioned they did acupuncture. Having attended the course run by Trixie Williams in Calne, she started to use the technique alongside regular western medicine and finds it a really useful therapy especially for the older ‘creaky’ patients with conflicting comorbidities. She has a keen interest in imaging, particularly ultrasonography.
Christel Kindly agreed to answer the following questions:
What are your feelings on how we currently manage this common debilitating condition in dogs?
There is a huge variation in clinical presentations, owner awareness, owner willingness to accept and treat their pet, and vet recommendations/involvement.
Some dogs have multiple limb lameness which can make it hard for owners to recognise there is a problem – in my experience, bilateral elbow lameness regularly presents like this; owners may not have noticed the ‘on eggshells’ gait.
There’s also an acceptance that it’s ‘normal’ for them to be stiff when older, and it can be hard to persuade owners that this is a sign of pain which could be addressed rather than just something to be resigned to. Despite our own lack of vocalisation when we have chronic pain, there is a perception that if dogs were in pain they would cry out. Some owners feel that our recommendations are too costly or are worried about side effects. A small group won’t take on board what the vet says when they advise of the painful issues, not because they are wilfully intending suffering, but because they don’t believe they would leave their pet in pain and they feel they have assessed things correctly.
In our profession, there is still a big variation in the recommendations given to clients. In the main I think most people would now advocate a multi-modal approach, but for a proportion it may be that NSAIDs are the only thing offered. I feel that using a combination of some or all of the following: weight control, supplements (though the evidence is not as strong as would be ideal), disease modifying diets and injections, changes at home, massage, physio, acupuncture AND anti inflammatories can be the best way to get the best quality of life for both owner and pet.
It’s so important for vets and owners alike to appreciate that fat tissue is metabolically active- not only does it make the patient heavier, stressing their skeleton, but it releases chemicals, cytokines etc which can change the body’s metabolism and can affect the pet’s health.
As a veterinarian what do you feel is essential for managing canine arthritis effectively?
Communication and education are essential for managing this complex and distressing condition. It’s so common! First we as a profession have to accept that we need to be better at seeing the issue, and much better at using the right kind of language when talking to owners. Making people feel guilty doesn’t have a huge yield in terms of long term revisits etc, we need to get them on board with understanding what is happening and how they and we can help.
Then talking through all the options to find the things which will work best for each individual in their lifestyle. We need to give enough time to these patients- the joy of my acupuncture sessions is I get time to talk through the case, look at videos, etc.
How do you see treatment options for arthritis progressing over the next ten years?
I hope that more vets will give time to these patients, and treat them like any other animal with a chronic disease. I imagine novel therapies will be developed, also I anticipate an increase in the use of physiotherapy and massage and acupuncture as people seek to use fewer ‘drugs’.
If you could have the opportunity to give one tip/ piece of advice to an owner with a dog suffering from arthritis what would it be?
I’d advise an owner with an arthritic dog to trust their vet when they say there’s something to be done. Be ready to engage in discussions about how things can be adapted at home and what’s available to help the dog, and if unsure, seek out a vet who has a passion for looking after these dogs. We are not all the same so find someone who suits you and your pet.
Christel Caderius van Veen
Castle Vets Pet Healthcare Centre