Alison  Holdam BVM&S MRCVS

Alison qualified as a vet from the University of Edinburgh in 2001 and, other than a brief period working for DEFRA, she has worked in small animal first opinion practice ever since. She currently works at both a private practice and an RSPCA clinic for people on low incomes. The majority of her time is spent consulting. A significant proportion of the dogs she sees on a daily basis have musculoskeletal issues and chronic pain and this is an area of special interest and concern.

 

Alison kindly agreed to answer the following questions:

When did your interest in the management of arthritic dogs arise?

I am a small animal general practitioner and for the last sixteen years have worked in a busy first opinion practice. Five years ago, I also began working at an RSPCA clinic for pet owners on low incomes.

Even though I’ve always had a strong interest in chronic pain management, it wasn’t until I started offering an acupuncture service that I had a revelation with regards to arthritic dogs. In both my current roles, the length of a normal consultation is just ten minutes, but the longer acupuncture appointments allow me time to do something which I feel makes a significant difference – really talk to owners. I have time to discuss all the owner’s concerns, the dog’s changing behaviours, things they’ve noticed that they’re not sure about, what the drugs are that we’ve been using. I can see the owners visibly relaxing and feeling better about things, just from being able to talk about them. It also allows me the opportunity to offer targeted advice and education on management strategies and prevention. Ultimately, I think this time for discussion proves just as valuable as the acupuncture.

 

Do you think the veterinary profession does a good job of managing and treating arthritic dogs?

I believe that, as a profession, we must adopt a more holistic approach to arthritic dogs. Adequate analgesia is top priority and multi-modal analgesia must be utilised, as the disease progresses, to address the different causes of pain. Owners can sometimes be scared of using these medications for their dogs and this needs to be addressed by careful explanation. However, more consideration needs to be given to other measures in addition – physical therapies by trained personnel, non-medical treatments such as acupuncture and robust owner education.

I think that, on the whole in general practice, we are just firefighting this condition. We use a quick blast of painkillers to extinguish the burning pain, when we should be attempting to prevent the disease occurring by helping owners to not supply the fuel for the fire, for example by discouraging high impact ball play. We should be slowing the progression of the disease by helping owners set firebreaks, such as laying non-slip floors and limiting weight gain. We should be spotting early warning signs by installing metaphorical smoke detectors, powered by education of owners, to detect signs of joint disease and pain.

 

What is the most important thing you have learnt from your years in general practice?

I believe early intervention is key and the main thing I have learnt from being in general practice is that people just don’t know. They don’t know that their dog is in pain, they don’t know that they are doing things which might be exacerbating that pain, they don’t know that there are simple measures that can make a big difference.

In addition, the majority of the clients I see are on tight budgets with uninsured pets and they don’t realise that there are things they can do to really benefit their dogs that carry no additional cost.

 

What, would you say, are the most important things to impart to an owner of a dog with joint disease, within a routine consultation?

Due to the demographic of low- income clients, my whole approach must reflect this and ensure that I suggest the most cost- effective treatment and management protocols. This forces me to keep things simple and I have condensed the most important things I would want to impart, in a routine ten – minute consultation, into seven points.

1. Recognise the clues your dog is giving you that they are in pain. They will not make it obvious to you, they will rarely cry out in pain, you must know what to look for.
2. The single most important thing you can do for a dog with joint disease is to maintain their weight within the normal range.
3. Maintain a consistent, low impact exercise routine.
4. Do not hold off on pain relief if it is recommended by your vet. Regular monitoring and blood tests will make it as safe as possible, but we must maintain an adequate quality of life. In general, a non-steroidal anti-inflammatory drug is the very least we should be giving dogs with chronic arthritic pain and we may then add in additional drugs as necessary.
5. See your house and all your daily activities from your dog’s perspective. Do they have to jump in and out of a high boot to go for their daily walk? Do they have to climb steep, slippery stairs to be able to sit near you in your home office?
6. Provide good nutrition and consider a prescription joint diet if you can afford it but don’t waste valuable resources, which could be spent elsewhere in your dog’s treatment, on supplements which you haven’t researched or checked with your vet.
7. A manicure can be a many-cure and prevent problems caused by altered gait. Maintain good foot care and have your dog’s nails regularly trimmed.