Nadine Lightbody is a first opinion vet who runs a chronic pain clinic at her practice in Leeds.
Nadine graduated from Glasgow Vet School in 2013. Her first job was in a small animal practice in Burnley, Lancashire where her interest in pain management began. In 2015 Nadine moved to Yorkshire and started working at Beechwood Vet Group in Leeds. She has since gained a GP certificate in Western Veterinary Acupuncture and Chronic Pain Management and runs a weekly chronic pain clinic for dogs and cats. She has a passion for client education and her main interest is improving the quality of life of her senior patients through a multimodal approach. She also has a growing interest in rehabilitation and canine fitness, mostly through owning an enthusiastic injury prone Cocker Spaniel who loves agility!
Nadine kindly agreed to answer the following questions:
What are your feelings on how we currently manage this common debilitating condition in dogs?
I personally feel that in the veterinary profession we can no longer justify the phrase ‘just getting old’. We are all under a lot of time pressure as well as expectations from our clients but I feel that too often arthritis is overlooked as an inevitable part of ageing in the dog and it can be tempting for it to be glossed over or shrugged off at a booster consultation for example. If there isn’t time to discuss problems in a busy consulting session then have a hand-out ready to give to clients or even better, write down the CAM website address and get the clients to come back once they have the basic information that they need.
Another common misconception amongst vets is that if your go-to anti-inflammatory doesn’t work or ‘stopped working’ then there is no more we can do for the patient. There are so many different medications and therapies out there these days, we have a duty to our patients to find what works best for each individual. Again, if you do not know what else to do or don’t have time to discuss these things fully with an owner then you should be looking to send the client to someone who can help.
With all of these things considered I believe that the message is slowly getting out there. Clients are starting to become aware of how serious the condition is and are seeking more help. We need to be ready to answer their questions when they come.
What would be your top tips to other vets on how to do an arthritis consultation?
- Be prepared. Give the owner a questionnaire so they can have a think about the sorts of questions you will ask before they come in and you do not have to spend so long asking them. It may sound obvious but read the full history – sometimes they may have had surgery 5 years before. This may be important.
- Ask for videos. Some difficulties are not easy to see in a consultation.
- Think about your consult room. Put down non-slip beds or yoga mats so the dog can stand or lie down comfortably. I sometimes use yoga mats as a pathway into my consult room for debilitated dogs.
- Chat first, then get your hands on the dog. This allows the dog to settle and feel less anxious but also allows you to observe the dog from a distance.
- Don’t go straight for the most painful area. If you suspect a hind limb problem, start at the front and work your way back.
- Remember the muscles! Not all arthritic pain comes from the joints. Make sure to note any tender or tense muscles especially in the back.
- Give the client information to take away. There will usually be a lot of information to take in for the owner. Having some bullet points written out, a pre-prepared hand-out or links to good information can be really valuable, especially on any new medication or treatments you prescribe.
How do you see treatment options for arthritis progressing over the next ten years?
There does seem to be a shift towards a multimodal approach to arthritis. Hydrotherapy and physiotherapy are becoming more popular. Most of my clients have started giving their pets nutritional supplements before they see me, there is a lot of work to be done to prove the effectiveness of supplements but this could improve in the years to come.
I am also hopeful that more good quality studies will be done on acupuncture for the treatment of osteoarthritic pain in the dog. There is strong evidence already that it does reduce pain transmission in the body and boosts happy hormones like dopamine. Anecdotally we have all seen dogs that respond really well to acupuncture and so I hope that in coming years it will become more accepted as a helpful adjunct to current therapy in conventional veterinary practices. In the same way that we are starting to harness a dog’s own stem cells to treat diseased joints we should also be harnessing the body’s ability to produce its own natural painkillers.
If you could have the opportunity to give one tip/piece of advice to an owner with a dog suffering from arthritis and chronic pain what would it be?
Be proactive. If your dog has had an injury please make sure to follow the vets instructions on rest and rehabilitation. This has the potential to prevent more severe damage down the line.
In the same way if you suspect or have had early arthritis diagnosed in your dog do not delay in starting to treat it. The condition will only get worse and your dog will only be in more pain the longer you leave it untreated. Sadly most of the patients that come to see me at my pain clinic have been suffering for many years. By the time I see them they have a lot of secondary back pain and often are over-sensitised to pain so that even the act of stroking or brushing them over sensitive areas can provoke a fearful response. These things can be prevented by early intervention.