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Five takeaways from the VOA Conference

I had a busy month of learning last month, attending the Veterinary Osteoarthritis Alliance Conference (VOACON) and BVA Live, a conference for veterinary professionals in all fields.


The VOA is a relatively new organisation which aims to bring together all professions (specialist and generalist veterinary surgeons and nurses, physiotherapists and allied therapists) to share and educate on best practice in caring for our patients with osteoarthritis. There are lectures and presentations on many subjects, plus a trade exhibition and it’s a very collaborative atmosphere, so I really enjoyed my visit.


It’s alway good to share what you’ve learned, so today I’m going to draw out my top 5 takeaways from VOACON.


1: OBESITY PREVENTION IS KEY



Unlike in people (and cats, we think) most cases of osteoarthritis in dogs is not just due to ‘wear and tear’ on joints but is secondary to a developmental condition or injury. This means it is very difficult to ‘prevent’ OA but lifestyle factors are so prominent in terms of how soon the signs of OA develop and how much they affect a dog’s quality of life.


Once a dog is born, its genetics cannot be altered to reduce the risk of OA. However, diet is a major factor that all of us pet owners can control. 


In a randomised controlled trial (one of the highest standards of scientific study) started in 1987, 48 Labrador Retrievers from 7 litters were paired up according to sex and bodyweight, then half the dogs allowed to eat as much as they wanted (CF), and half were given 75% of this (DR group). All dogs were fed the same dry kibble diet. The researchers then followed the health outcomes of these dogs over their lifetimes and the results are fascinating. (As an aside, the researchers actually had to switch up the programme when the dogs were 3 years old to prevent serious obesity occurring, but they still had a CF group and a DR group to compare). 


The CF group measured around 6.7/9 body condition score which equates to around 15-20% over ‘ideal’ - these dogs did not become morbidly obese. However this extra bodyweight was associated with:

a 1.7 year reduction in average lifespan

a whopping 42% prevalence of radiographic (xrays) changes associated with hip OA at 2 years old, compared to 4% in DR dogs - just take that in - that's nearly HALF of the overweight dogs, at TWO YEARS OLD!!!

77% prevalence of OA in two or more joints at 8 years old, compared to 10% among DR dogs


These results show that restricting our pets’ food intake to maintain a lean bodyweight can really influence how soon and how severely they develop osteoarthritis. Given how early the signs of OA can appear on x ray, this is something that needs to be taken into account from puppyhood and is something we all have control over, unlike many other aspects of our pets’ health.



2: NOT ALL LASER THERAPY IS CREATED (OR PERFORMED) EQUALLY

Laser therapy can be performed with a lot of variables: wavelength, power, power density, continuous vs pulsed etc. Different wavelengths get absorbed by different molecules in the body so using the incorrect settings can mean the photons (laser energy) do not penetrate the tissue you are targeting and lead to ineffective treatment or potentially even tissue damage.


Do you want healing? Then the wavelength should be set so that it is absorbed by the haemoglobin in the blood to increase oxygenation of the damaged tissues.

Looking for pain relief? Then a longer wavelength is required to penetrate the lipid layer of the nerve cells which transmit pain signals.

Do you want heating? A mild warming effect may be beneficial for stiff and sore muscles but overheating will lead to cell damage and death.


Ask your laser therapist questions to be sure they know why they are using the laser machine on the settings they are, and what they are aiming to achieve for your pet.



3: KEEP THEM MOVING

Too often in the past, the dogma has been that if an animal develops a limp, rest and anti-inflammatory medication is the treatment of choice. 


However we now know better. Rest is important in the early stages of an injury but even with acute flare ups of chronic OA we need to get our animals moving (gently) as soon as possible. 


Immobilisation leads to:

  • atrophy (shrinking and cell death) in cartilage, muscle and bone tissues

  • reduced capacity for load bearing in tendons

  • Ligament elongation

  • Joint instability and reduced range of motion

These changes might become irreversible if the rest is prolonged (>4-6 weeks)


So we need a controlled exercise plan to help ensure that we are maintaining an animal’s mobility as best as possible, plus a ‘flare management plan’ for those times when a pet meets a friend and plays a bit more vigorously than usual, or trips and strains themselves, or just overdoes it on a walk.


For great resources on flare management, head to www.caninearthritis.co.uk



4: PLAN AHEAD

Physical interventions in a pet’s environment can be really important to maintain their quality of life as their mobility decreases.  If the cat used to prefer sitting on high and looking down on the household, but can no longer reach high places, it can no longer fulfil that desire which is at best frustrating, and at worst, stressful. Stress can exacerbate pain and intensify suffering.


If that dog used to love meeting and greeting in the park but can no longer jump in the car boot to get there, he too will suffer from social isolation and boredom.





We know arthritis is a progressive disease and although our efforts can slow down that progress, decline is inevitable in some form. So have a look around and plan ahead. 


  • Install cat ramps or intervening shelving to aid the cat to reach that high place.  

  • Cut the side out of the litter tray before they start having accidents because they can’t step over it.

  • Train your dog to use a ramp or steps to the car boot before they are feeling too stiff and frail to attempt a new manouvre.  

  • Place extra bricks or a ramp at the back door so they can still freely enter and exit the garden when they choose.

That way, the pet’s routines can have as little interruption as possible as they progress, maintaining their quality of life.



5: ARTHRITIS TREATMENT NEEDS TO BE A COLLABORATIVE EFFORT

A vet like myself, who is interested in pain management, can study and read to become an expert in the field of arthritis, why it develops, what tissue changes are occurring, what treatment options there are. But a disease doesn’t operate in a vacuum. It affects an animal. And that animal lives in an environment, with devoted owners. 


If I prescribe a medication that the animal won’t take, or which the owner feels is causing unwanted side-effects, or if I prescribe an exercise plan that the owner is unable to carry out, how is that benefiting my patient?


Our pets are in our lives because they form a companion bond with their humans and that is what makes their lives, and ours worth something. 


So as clinicians, as well as informing our pet owners of what we know, we need to discuss their concerns with them. How do they feel about their pet’s mobility or lack of it? In what ways has their relationship changed since the pet began to show signs of OA? Treatment should always have pain relief as a primary aim, but in order to treat the whole animal we need to take into account their quality of life and social relationships are a key part of this (especially for a social species such as dogs). 


We need to take into account the concerns and values of the pet’s family and form a plan together that everyone can engage in, for the benefit of the pet. 


This is what I am aiming to do with my Recover Pain Management Programme - see below for more details.


CPMS vet flyer
.pdf
Download PDF • 12.57MB

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