CAM blogs

CAM Meets Siobhan Menzies

Siobhan kindly agreed to answer the following questions.

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

While I feel that OA management in veterinary practice has improved a lot over the last 30 years, there is still considerable room for improvement.

When I graduated there was a reluctance to use pain relief at all in small animals in case it “masked” the pain. When I started my acupuncture and pain management practice Holistic Pet twenty years ago, I was regarded with amusement and suspicion by veterinary colleagues, but pet owners were interested and delighted. Now we have a much greater understanding of how chronic pain develops in mammals and its long-term consequences. As a result, medical pain management is well recognised in most veterinary practices.

At the same time in many general veterinary practices the approach to the chronic OA patient can be somewhat simplistic. Many vets respond to an OA patient by prescribing rest and NSAIDs and while this is very appropriate in the short term for a flare up, it is inadequate when OA causes long term pain and reduced mobility. Prolonged periods of rest can lead to negative consequences such as muscle and bone atrophy, loss of joint range of motion, ligament and tendon weakness, weight gain, depression and loss of stamina and fitness.

Multimodal analgesia, that is the use of analgesic medications and pain-relieving therapies is, in my opinion a more effective approach to the chronic OA patient as each case is different. Looking at the patient from a holistic (or whole-istic) approach is essential.

Assessing the patient’s environment to see what changes would be required such as non-slip floors, raised food bowls, ramps etc is the first step and CAM has been at the forefront of educating the veterinary profession on these issues.

An in-depth assessment of the individual patient’s needs is very informative therapeutically but time consuming and this is one of the main limitations in GP vet practice. This assessment would determine whether the issues are down to heightened pain sensitivity/central sensitisation, myofascial pain, loss of joint range of motion, reduced muscle mass or tone, obesity, neurological compromise, a condition requiring surgical intervention or a combination of some or all of these. Based on this assessment a therapeutic management program can be created for each patient which might include additional medications targeting the class of pain present, surgery, physical therapies such as acupuncture, physiotherapy, therapeutic laser, hydrotherapy, intra articular therapy, therapeutic exercise, massage, shockwave etc. The aim is to reduce the pain so that the patient can get back to a more normal quality of life and level of exercise.

A few vet practices have centres offering the full range of therapies, but they tend to be in the minority and clients tend to find therapists through social media and word of mouth. I would like to see a more vet directed approach where vets recognise the chronic pain and OA patients and either manage them with an in-house rehab centre or refer to trusted paraprofessionals as part of an “extended team” under vet supervision. Clients could then have confidence that their pet’s pain management was being managed safely and appropriately.

At the moment the veterinary education on OA at university level seems to be limited to medical and surgical management and it is down to individual vets, vet nurses and practices to seek out further education from CPD companies and bodies such as CAM or VOA. Given the extent of the OA problem in small animals it would seem sensible to provide information on both medical and non-medical OA management at university level so at the very least newly qualified vets and vet nurses would have an understanding of what each therapy can and cannot achieve and what qualifications are required to provide each therapy safely and professionally.

In short, I would dearly love to see multimodal analgesia education covering both pharmaceutical and physical therapies as part of the veterinary syllabus for vet nurses and vets. I feel that this would lead to more practices providing more effective options for OA pain management in practices, in particular using the excellent skill sets of vet nurses and paraprofessionals under vet direction. The impact that this would have on patient suffering and welfare would be immense. Unfortunately, this is currently regarded as a “low profit” branch of veterinary medicine which is a short-sighted approach. I think we have to have a change of mindset as a profession and realise that any practice that puts patient comfort and welfare at the top of the agenda will be highly rated by clients and successful as a result.

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

Personal attributes which are essential for managing canine arthritis effectively are empathy, patience and determination. One needs to have compassion for the patient and their suffering, understand that this is a condition for lifelong maintenance and there is no quick fix and be resilient in your efforts as each patient is different and may not respond to every therapy.

You also have to have a clear understanding and knowledge of the consequences of arthritis. Comprehension of how this condition affects joints and the secondary effects of pain and loss of range of motion on the rest of the musculoskeletal system is crucial. Only when you fully understand these processes can you address them with the range of therapies available to you.

Finally, you need to have a deep knowledge of the therapy which you provide including its benefits and limitations. From a practical point of view, you do need to have some method of providing pain management and mobilising the patient. The motto of HolisticPet is “Ramp down the pain; Retrain the brain; Increase the strain.” In other words, you must first manage the pain with whatever means you have, then teach the animal to move correctly again and finally get them as well conditioned and strong as possible to reduce the impact of flare ups in the future. This does not necessarily mean that you have to have lots of expensive gadgets and machines, however. The bulk of research supports the use of cryotherapy (ice packing), passive range of motion exercises and therapeutic exercise for many aspects of rehab and evidence for some of the “gadgets” is very variable. It’s amazing what you can achieve with cryotherapy, massage, myofascial release, and a tailored exercise program. If a case needs a therapy which you don’t provide, then be prepared to refer it to somewhere that does. Patient welfare must come first and having a good relationship with other therapists and practitioners creates a support network which is beneficial for you and your patients.

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

I think the trend for more targeted pharmacological products will continue such as Librella, which targets nerve growth factor. Intra articular treatments may also become more commonplace.
Technology for measuring outcome measures of treatments are likely to become more sophisticated e.g. the use of AI. There is also a device being tested which may be able to record the output from C fibres which are involved in pain transmission. Such devices will make it easier to monitor the effectiveness of treatments and may be able to quantify the individual’s experience of pain.

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?

“Keep them light and keep them fit” would be my tip. Fat is a painful organ and even without any underlying pathology it will spew out painful inflammatory chemicals so the lighter an arthritic dog is the better. Low impact movement can help with pain management, maintenance of joint range of motion, muscle mass and strength all of which are important for long term mobility.

Siobahn Menzies BVM&S, CCRP, GPcert (WVA&CPM), MRCVS

Siobhan graduated from the Royal (Dick) School of Veterinary Studies in 1990. During her 12 years in general practice, she studied acupuncture with the Association of British Veterinary Acupuncturists, eventually serving as council member. Siobhan attended the Canine Rehabilitation Practitioner programme provided by the University of Tennessee. Inspired by these courses, Siobhan established HolisticPet, Northern Ireland’s first veterinary pian management and rehabilitation practice, partnering with Earlswood vet referrals to provide hydrotherapy via underwater treadmill. HolisticPet now offers veterinary-led pain management clinics at three centres in Northern Ireland.

Siobhan holds a CCRP (Canine Certified rehabilitation Practitioner) qualification, a RACE-approved university qualification in canine rehabilitation and a GP certificate in Western Acupuncture and Chronic Pain. In addition, Siobhan has studied Canine Sports Medicine.

Siobhan remains passionate about pain management and continues her studies in all aspects of multimodal analgesia and is currently preparing a practical veterinary rehabilitation course for vets and nurses. She serves as a council member for AVSPNI ( Association of Veterinary Surgeons Practicing in Northern Ireland) and is a member of the Veterinary Osteoarthritis Alliance Advisory Board.