Ashleigh Thurston BSc (Hons) VN RVN
Ashleigh graduated from Myerscough University Centre with a FdSc in Veterinary Nursing with Distinction in 2016. She has since completed her BSc Top-up in Veterinary Nursing and graduated from Myerscough University Centre with First Class Honours in 2019. She has experience working in a university referral hospital, general practice and clinical pathology laboratory. After qualifying as a RVN she worked at a busy first opinion practice and has spent the last 3 years working for the University of Liverpool Small Animal Practice and is involved in the training of final year undergraduate veterinary students. She recently presented her own research at BVNA Congress Research Bites 2019 titled ‘An investigation into RVN perceptions associated with the use of pain scoring systems in canines undergoing ovariohysterectomy in first opinion practice in the UK’ with the abstract published in the Veterinary Nursing Journal. Ashleigh’s main areas of interest are anaesthesia, acute and chronic pain management, evidence-based veterinary medicine and weight management and theatre nursing.
Ashleigh kindly agreed to answer the following questions:
What are your feelings on how we currently manage this common debilitating condition in dogs?
I feel that osteoarthritis (OA) in canines in general practice is often managed with a heavy reliance of pain relief, however it was suggested by Carmichael (2006) that the ABCDE (analgesia, bodyweight, control, disease modification, exercise) strategy may be beneficial in the management of degenerative joint disease (DJD) as it provides a multi-modal and holistic approach to treatment. This is something that is particularly important in the management of OA due to the complex nature of the condition and the chronic pain it results in, and owner compliance is vital for successful management of these cases.
As a RVN, what do you feel is essential for managing canine arthritis effectively ?
RVNs can play such a massive part in the early detection of OA in patients through the use of various nurse clinics and can help engage pet owners before referral to the veterinary surgeon. Once a pain management plan has been devised with the veterinary surgeon, RVNs can assist owners with regular OA clinics in practice to offer further advice and support on weight optimisation, home modifications and nutritional supplements.
Weight management is a great area that RVNs can take ownership of and is essential in the treatment of OA. A recent study by German et al (2012) found that overweight dogs were more likely to suffer from chronic pain, reduced mobility and have a reduced quality of life in comparison to dogs of ideal weight. Therefore, weight optimisation should be started at diagnosis or OA In order to slow down further joint degeneration and aid in the reduction of chronic pain (Pettit and German 2015). A study of 16 overweight dogs with OA carried out by Marshall et al (2010) found that a total weight loss of 6.10% and above showed a significant decrease in lameness, thus further supporting the implementation of weight loss strategies in the management of OA.
For pain management to be effective in OA cases it is vital that all members of the veterinary team have a solid understanding of the pathophysiology of chronic pain, the disease process involved in degeneration of the joint, assessment methods and modalities of treatment. A team based approach and client involvement is key in any pain management case and allows for the provision gold standard care (Epstein et al 2015). However, the most important component of OA management is owner compliance and therefore it is vital that owners feel supported by their veterinary team in practice and the use of support materials such as those on the CAM website can help bond clients and aid their understanding of the condition and the importance of a multi-modal approach for successful outcomes.
How do you see treatment options for arthritis progressing over the next ten years?
In the past two decades there has been huge advancements within veterinary medicine and an increase in awareness of animal welfare and therefore an improvement in pain management. I am hopeful that chronic pain management strategies, chronic pain species specific pain scoring systems and treatments such as stem cell therapy will continue to develop and help many patients suffering from degenerative joint conditions in future years.
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?
My top tip to owners would be to intervene as early as possible when clinical signs are noticed to help slow the progression of the condition and improve your pets quality of life by applying home modifications and weight management strategies from diagnosis. Never be scared to contact your veterinary practice for information on your pets management and attend a OA nurse clinic with your RVN for support and advice on making changes to improve your pets comfort-we don’t bite!!
References:
Carmichael, S. (2006) ‘Putting theory into practice – best practice management for osteoarthritis’, European Journal of Companion Animal Practice, Vol.16, No. 1, pp. 27–31. Epstein, M.E., Rodan, I., Griffenhagen,G., Kardrlik, J., Petty, M.C., Robertson, S.A. & Simpson, W. (2015) ‘2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats’, Journal of Feline Medicine and Surgery, Vol. 17, No. 3, pp.251-272. German A. J., Holden S. L., Wiseman-Orr M. L., Reid J., Nolan A. M., Biourge V., Morris P. J. & Scott E. M. (2012) ‘Quality of life is reduced in obese dogs but improves after successful weight loss’, Veterinary Journal, Vol. 192, pp. 428–434. Marshall, W.G., Hazewinkel, H. A., Mullen, D., De Meyer, G., Baert, K. & Carmichael, S. (2010) ‘The effect of weight loss on lameness in obese dogs with osteoarthritis,’ Veterinary Research Communities Vol. 34, No. 3, pp. 241–53.