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CAM Meets Kirsty Cavill

Cam Meets Kirsty CavillKirsty kindly agreed to answer the following questions.

What are your feelings on how we currently manage this common and debilitating condition in dogs?
We are better than we have ever been, but we are not there yet. We must strive to engage, educate, enable, and empower all those associated with and working within the field of pet care in relation to OA management. The appropriate signposting of risk factors plays a key role in managing this disease, as does employing a proactive, coordinated, and interdisciplinary approach. We must move away from the perception that OA is only associated with senior life stages and older dogs, and instead work collaboratively to raise awareness of the prevalence amongst younger dogs.
Referral to paraprofessionals, is not as common as I’d like to see. Some practices have in-house rehabilitation facilities, but others rely on referring cases outside of their practice environment. By developing a wider scaffold of support, alongside a coordinated team approach, we can gain confidence is case sharing, to elicit the best evidence-based treatment plans for our patients.

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

OA is caused by an interplay of risk factors. It is not a single disease, but the result of a combination of genetic, physiological, and environmental factors. Therefore, a proactive approach to the identification and management of this condition is vital if we are to mitigate avoidable risk factors. We must close the gap between disease prevalence and treatment rates through a coordinated, interdisciplinary approach, which will elicit a comprehensive treatment plan and maximise the patient’s health related quality of life.

Just like a jigsaw, we need all the modalities or a treatment plan to be in the right place, to achieve the best result.

The ability to experience pain is a trait common to all mammals and the pain states associated with OA are complex and transient, often involving mixed pain types. Pain is a multi-dimensional phenomenon, which is not static or predictable, but often transient in nature. It will impact directly on quality of life for both pet and owner. Pain is an individual experience and must be considered on a patient-by-patient basis. Under recognised and under-managed chronic pain can result in premature euthanasia. Conversely, appropriate recognition and management of chronic pain can be as life preserving as any other medical treatment. Therefore, regular medication reviews are a necessary and valuable part of any OA management plan.

However, medication alone is not a comprehensive approach. We must always consider the environment in which the dog lives, alongside their nutrition, weight management, lifestyle, appropriate exercise, and concurrent disease processes, as part of a basic OA plan.

Veterinary nurses are ideally placed to be advocates for their patients and play a major role in developing and implementing their multi-disciplinary care plans. Nurse clinics are a great conduit through which to support patients diagnosed with OA, and to act as a platform from which to educate the owners when they bring in their puppies and young dogs for routine health checks.

Referral for physical therapy is a vital part of any OA management plan. It is important this happens in a timely manner, to compliment other modalities of treatment. We want to avoid prolonged periods of rest or immobility as this can lead to undesired consequences such as muscle and bone atrophy, reduced joint range of motion, ligament and tendon weakness, and a reduction in stamina and cardiovascular fitness.

Through implementing a holistic approach, treating the whole dog, and not just the affected joint, we are better able to slow down progression of this degenerative joint disease, and maintain functional and pain free mobility for longer.

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

Knowledge within the model of OA case management is constantly changing and advancing with the development of pharmaceutical, medical, and non-medical rehabilitation techniques, lifestyle, and exercise adaptations. Through a better understanding of the disease process, new treatment options will continue to be developed.

There will be further advancements in the development of targeted pharmaceuticals. Utilising medication more effectively and consistently through a poly pharmaceutical and multimodal analgesia approach, will better aid in the management of the various pain types, commonly associated with OA.

We will continue to gain more knowledge and further our understanding of OA, as we appreciate the relevance of a One Health approach. The One Health concept recognises that the health of humans, animals and the environment is interlinked. To maintain optimal health, depends upon a collaborative and multidisciplinary approach, carried out at local, national, and global levels. OA is a global disease, prevalent amongst humans and animals, and associated with variable clinical presentations and diverse phenotypes. A One Health approach to OA, therefore, demands coordinated information transfer, a united approach to research, and the subsequent implementation of new treatment options.
I also foresee an increased recognition and utilisation of prehabilitation and rehabilitation in the management of OA, and therefore would expect to see an interprofessional team become part of the norm, for OA cases.

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?

Take ownership of your pet’s health journey and recognise everything that is within your control. You’ll hear veterinary professionals say this over and over, but weight management is a key factor in the multimodal management of osteoarthritis. Keeping your dog at their optimal body condition score (BCS), is one of the greatest single gifts you can give them. There are two mechanisms by which an above ideal body condition score can exacerbate the clinical signs of OA.

  1. A physical effect from the forces exerted through the affected joint.
  2. Biologically from the active nature of adipose tissue (body fat). Adipose tissue produces a mixture of hormones and biochemical molecules which are pro-inflammatory in nature and may therefore trigger a low-grade inflammatory state, which could contribute to further joint damage and pain.

Your veterinary team are highly skilled in nutrition and weight management and can support you and your dog to ensure they maintain an optimal BCS throughout all life stages.

Kirsty Cavill BSc (Hons) RVN

Kirsty qualified as a Veterinary Nurse in 1991 and has experience working in small animal, mixed and zoological settings. She is currently Director, Head of Clinical Services at The Vet Connection, and is also a qualified Clinical Canine Myotherapist and owner of Paws Canine Myotherapy Care.

Kirsty is a volunteer nurse with Canine Arthritis Management, volunteer Team Lead with the Veterinary Charity Streetvet, and a member of the International Association of Animal Therapists.

Kirsty has completed an honours degree in environmental science and the Royal College of Veterinary Surgeons (RCVS) Edward Jenner Veterinary Leadership programme. She is a trained Mental Health First Aider supporting colleagues within the veterinary profession.

Kirsty regularly writes articles for publication and presents at industry relevant events, on senior pet care, osteoarthritis, and pain management.

In 2021, Kirsty was awarded the RCVS Veterinary Nurse Golden Jubilee Award and the British Veterinary Nursing Associated Impact Award.

In 2022 Kirsty was invited to be chapter editor on an industry relevant book project (published in Feb 2023) – One Health for Veterinary Nurse and Technicians.

In October 2022, she was awarded the Blue Cross Veterinary Nurse of The Year, and in 2023 Kirsty was invited to become a member of the Veterinary Osteoarthritis Alliance Advisory Board.