Diane Messum MCSP, HCPC, BSc(Hons), MSc VetPhysio, ACPAT Cat A RAMP
Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Herts, UK

Diane has been a Chartered Physiotherapist since 2002, qualifying from the University of Birmingham. She went on to specialise in musculoskeletal outpatients and hand therapy where she developed knowledge and skills that were key to her current practice within the small animal field. Diane completed her Masters Degree in Veterinary Physiotherapy in 2007, awarded by the Royal Veterinary College, London, when she started her owner private practice for equine and small animals. After dividing her time between both human and animal species, she went on to specialise in small animals, joining Davies Veterinary Specialists to head up and develop the Therapy Services in 2011. This came with the fantastic opportunity to work alongside the Orthopaedic and Neurology services, just two of the many specialists’ services at Davies Veterinary Specialists, one of the largest and most diverse small animal referrals hospitals in Europe. Growth of the service led to the launch of the Davies Therapy and Fitness Centre in January 2017 where services now include Physiotherapy, Hydrotherapy, Splinting and Orthotics and a Pain Management Clinic including Acupuncture. Diane works alongside the Orthopaedic and Anaesthesia and Pain Specialist teams in addition to other members of the Therapy Services team to optimise the quality of life for patients with long term co-morbidities such as osteoarthritis. Diane also has a special interest in the use of splinting and orthotics for the conservative management of musculoskeletal injuries. Diane continues to share her own passion for the work she does by lecturing and being an active clinical educator for the Masters Veterinary Physiotherapy Programmes in the UK.

 

Diane kindly agreed to answer the following questions:

What are your feelings on how we currently manage this common debilitating condition in dogs?

Thanks to the wonderful work that CAM is doing, there is an increasing awareness of canine osteoarthritis in all four corners of the globe. Having worked for 12 years as a Chartered Physiotherapist in the NHS and then private healthcare treating a broad spectrum of outpatients, including those with osteoarthritis, I was astonished that when I made the initial transition to specialising in small animals that more was not being done for our pets with osteoarthritis. I have now been practicing veterinary physiotherapy for 14 years and have seen the knowledge and awareness of osteoarthritis rapidly grow and management options expand during this time. With greater emphasis on ‘one health’ we are learning so much from between species and moving more towards the holistic and team approach to minimise pain and optimise our pets quality of life. I am fortunate to work in a referral setting where we offer Orthopaedic, Pain Management, Physiotherapy and Hydrotherapy services. Following examination we collectively determine an individualised treatment plan for every one of our patients. I would love to see a similar approach disseminated to all primary care settings.

 

As a Chartered Physiotherapist what do you feel is essential for managing canine arthritis effectively?

Early detection of clinical signs related to osteoarthritis can help veterinary professionals advise caregivers on immediate and long term management for their pet. This can slow down the destructive processes of osteoarthritis. No pet with osteoarthritis is the same, each with varying degrees of severity. For example, radiographic analysis in people with knee osteoarthritis has identified that one person might have severe osteoarthritic changes on x-ray with no clinical signs of pain or loss of function and another may have very mild osteoarthritic changes with significant clinical signs of pain and reduced function. Each treatment plan is patient specific and needs to be adapted as the disease progresses to optimise the patients quality of life.

I regularly see patients presenting to the clinic with another condition and on thorough subjective and objective clinical assessment I discover that there are signs of loss of joint range and muscle atrophy associated with subtle alterations in weight distribution to reduce load on an uncomfortable limb. The caregiver often has not noticed this previously because their pet has not been obviously lame. The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations for human health and care in England and they recognise that the three most valuable things we can do for our patients diagnosed with osteoarthritis are:

1. a) Offer access to appropriate information about osteoarthritis and how to manage it
2. b) Aerobic activity and exercise (including a targeted exercise regime for local muscles)
3. c) Weight management advice.

These items are accessible to everyone, regardless of social and environmental background, and can be most effective with an early diagnosis of osteoarthritis. A bi-annual clinical examination from a qualified veterinary physiotherapist can help in early detection of clinical signs related to osteoarthritis and facilitate communication between the other members of the veterinary team vital in creating a patient specific treatment plan that works for the patient and their caregiver.

 

How do you see treatment options for arthritis progressing over the next ten years?

A growing number of pet caregivers have a greater interest in minimally-invasive treatment methods to optimise their pets quality of life. With ongoing research and development into tissue engineering, a method to improve or replace damaged biological tissue, there is huge potential for this, in combination with other treatment methods, to enhance our patient outcomes.

I am grateful to be a member of the pain management team at Davies Veterinary Specialists but I hope there will be greater collaboration between the veterinary surgeon, veterinary nurse, veterinary physiotherapist and other health care professionals within primary care practices and a greater understanding of their respective roles within the multidisciplinary team. I hope that human medicine and veterinary medicine will continue to learn from each other to deepen our understanding of osteoarthritis and the best practice for management of this.

 

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?

There are many pieces to the puzzle for osteoarthritis management and not all of them will suit an individual pet or caregivers circumstances with some puzzles having fewer pieces than others. The most effective things you can do for the osteoarthritic pet cost little or no money. Making small environmental changes and changes to everyday activities can make a huge impact on you and your pets ability to cope with their condition. A qualified veterinary physiotherapist can advise you on these changes in addition to the benefits of other adjunctive therapies including targeted strengthening exercises, hydrotherapy, manual therapies and electrotherapies, for example.  Following initial assessment, we will discuss a management and treatment plan based on your pets needs and this is normally re-evaluated on a regular basis. Having regular physiotherapy and hydrotherapy may not be possible for some but, whatever your circumstances, please do not underestimate the value that just one veterinary physiotherapy consultation can have to help you and your pet.

 

Diane Messum
MCSP HCPC BSc(Hons) MSc VetPhysio ACPAT Cat A RAMP
Chartered Physiotherapist
www.vetspecialiststherapy.co.uk
Davies Veterinary Specialists, Higham Gobion, Hertfordshire, SG5 3HR