CAM blogs

CAM Meets Drew Tootal

Drew kindly agreed to answer the following questions…


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

I think that most vets manage OA the best way they can within the constraints they are faced with, be it time, finance, or specific circumstance. I believe that more can be done though, and it starts with education. A full appreciation of circumstances leading up to the traditional arthritic dog is not that common. Understanding how the physiology of the joint changes, what causes the pain and where it is and most importantly, what can be done about are lacking. I think that part of this is the ‘normalisation’ of OA in companion animals – it is expected that animals will get it, it is unavoidable, and you only need to do something when the animal is limping. We need to turn this on its head and actively educate vets and owners that arthritis starts with an inflamed joint, plain and simple. There will likely be no bony change (at which point OA is often crossed off the differential list) but this is the stage at which the accepted management strategies like weight control, diet, supplementation, exercise programmes, and physio/hydrotherapy can make a tremendous difference. This is also the best time for the new and exciting developments in regenerative medicine. If we get the owners on board, then together we can change the future for that animal.


As a veterinary professional what do you feel is essential for managing canine arthritis effectively?

If I had to use one word – time! Time to really think about why a joint is inflamed, and what we can do about it. Time to listen to the owners, especially for those subtle tells that might suggest that an animal is suffering from arthritis even though there is no limping. Time to go and do a basic walk up and trot up in the car park. Time to educate the owners and signpost them to the plethora of fantastic learning resources there are. Time for expectation management and to explain that a diagnosis of OA is the start of a marathon journey not a short sprint or magic bullet. Sadly, time is a scarce commodity, but this is where the use of nurse led OA clinics, online support groups, and the use of dedicated musculoskeletal clinics and associated supportive therapists can make all the difference. Let someone else do the leg work (forgive the pun!) to stabilise the animal, and then continue its management in the practice.


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

There is a lot of research going on into the pathogenesis of arthritis and, as we understand that more, I think that the logical direction of travel will be in the modification of the disease. An example of this would be in the seeming epidemic of cranial cruciate disease. At present, how the degeneration in the joint leading to the rupture of the ligament is imperfectly understood. We can only focus, therefore, on mechanical stabilisation through the variously available surgical options, and then systemic pain relief in the third of dogs that will go on to have continuing joint pain. This does nothing to address the risk of degeneration in the cruciate of the other leg. If we can understand how that degeneration is triggered, that must be the target to then prevent it. Diagnosis at an early stage before rupture through gait analysis, synovial fluid sampling, maybe even the development of diagnostic biomarkers, would allow us to prevent this debilitating condition.


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?

Please don’t wait! You know your dog better than anyone and if there seems to be something not quite right then seek help. Horribly arthritic joints with bony changes don’t appear overnight, and the first signs of this insidious disease are unlikely to be as simple as a limp. Behavioural changes such as being less affectionate or a bit reserved, having to be asked to go for a walk instead of bouncing at the door, that little wiggle of the back legs before jumping up that they didn’t do before – these can all be signs of arthritis. There are many more and our pets will tell us if they are in pain, if only we listen.

If we treat early, we stand a chance of improving quality of life. The longer its left, the fewer options there are.



Drew Tootal – BSc BVSc MSc (Res) MRCVS

Drew graduated from the University of Liverpool School of Veterinary Science in 2004 and joined the Royal Army Veterinary Corps just a few months later.

He spent most of my career working with Military Working Dogs, selecting them for training, looking after them during their time in service, and even deploying with them to Iraq!

Drew spent six and a half years in command of the Veterinary Training Squadron at the Defence Animal Training Regiment in Melton Mowbray, caring for the Regiment’s dogs and horses, and being a referral centre for all of Defence’s working dogs across the UK and deployed on overseas operations. This has included breeds such as Labradors, Spaniels, and German Shepherds, plus a few more unusual breeds like the Irish Wolfhounds and even a German Jagdterrier! Some of his most enjoyable times in the Army were spent caring for the ‘old and bold’ dogs as they prepared to leave service and become family pets. Lameness assessments, radiographic surveys looking for signs of arthritis, treatment and exercise plans, and managing work and training formed part of a holistic plan tailor-made for each dog.


Drew has a passion for improving quality of life in dogs and is very excited to be able to partake in Nupsala Musculoskeletal Clinic’s goal, to help improve the treatment and management of chronic pain.

When not in work, Drew, and his wife, who is also a vet, try to keep up with their two young children and enjoy travel, natural history, and generally being outdoors.