‘Huge opportunities’ for VNs in managing OA - Veterinary Practice
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‘Huge opportunities’ for VNs in managing OA

Veterinary Practice reports on a recent round-table discussion on the role of nurses

WITH an estimated 20% of dogs
over one year suffering from canine
osteoarthritis (OA)1, can veterinary
nurses play a greater role in the
management of this important

Sadie Foreman, RVN, of the
Eastgate Veterinary Group in Suffolk,
believes they can, and told delegates at
an osteoarthritis round-table meeting
held earlier this year that VNs have a
key linking role between vet and client.

Ms Foreman suggests that it can
often be easier for nurses to spot the
first signs of OA: “VNs usually have
more opportunity to spend time with
both the owner and dog, for example
at weight and obesity clinics. They also
have more access to in-patients and so
will often pick up on things.

“Owners will take more time to
discuss a number of issues regarding
their pet which means that the first
signs of OA may well be noted by a
nurse, rather than the vet.”

Merial veterinary adviser Mark
Riggs agreed and pointed out that the
vet will usually be focusing on the
condition that the dog has come in for,
whereas a nurse will tend to take a
more holistic view.

“VNs play a valuable role in picking
up on issues such as stiffness and OA,
and nurse communications to channel
this information are becoming more
part and parcel of everyday practice. I
believe this benefits the animal, the
owner and ultimately the practice as it
strengthens the relationship with the
client as they have a healthier, happier

The delegates discussed the use of
clinics and agreed that they are a useful
tool in encouraging clients back into
practice for the on-going healthcare of
their pets. “The time spent at these
clinics also tends to be more relaxed,
and clients usually open up better for
the nurse whereas they will often tell
the vet what they think he or she wants
to hear,” Mr Riggs said.

One practice that has found weight clinics useful is Penmellyn Veterinary Group in Cornwall. The small animal
clinical director, Colin Whiting, noted
that his practice sees a lot of dogs with
OA, and that VNs play a significant
role in their management. “These
clinics are very popular and clients
become very comfortable in dealing
with a well-trained nurse.”

Mr Whiting discussed the role of
the VN in terms of what is within their remit from an RCVS perspective. “VNs
can do more than the usual
measurements of taking pulses, etc.
They can also use a grading system to
assess severity of pain. “If a grading
system were to be used, a subjective
analysis could then be made by the
owner in conjunction with the VN.
This system could stimulate the client
to think about how the dog is acting and behaving, and help them to
notice any

“Many clients
think that the dog
is just getting ‘old’,
discussions with
the nurse using
explanatory diagrams could help match
the dog to the level of the condition.
As well as the obvious welfare benefits to the animal, encouraging the client to work together with the VN helps cement client loyalty which ultimately benefits the business.”

Laura Baster, RVN, of the Veterinary Practice in Braintree Essex, pointed out that many dogs visiting obesity and veteran clinics may well also have OA. However, she added that it must not be forgotten that the nurse is restricted on clinical and diagnostic discussions that she is able to have with
cement client the client.

“We can of course point out that a visit to the vet to discuss the animal’s associated conditions may be beneficial. If appropriate, it can also be helpful to raise the issue with the vet so that, for example, with a case of suspected OA, the vet can examine the animal at the client’s next appointment.

Diagnosis and prevention

Tom Fitzsimons of Garden Lodge
Veterinary Clinic in County Down
explained that after his practice had
sent out 600 letters on cardiac failure,
250 additional people came through
the door within four months! It is likely
therefore, that a similar campaign for
OA could also work. “The initiative
also helped us to pick up on other
conditions, thus boosting business and
client loyalty at the same time.”

Lowri Davies of The Smart Clinic,
Cardiff, believes that practices could
provide greater customer added value
through further VN skills training.
“OA as a ‘diagnosis’ is too broad as the
condition varies considerably from one
animal to another. The early stages in
particular can be very manageable and

“A key role for us in rehabilitation
is to teach vets and VNs what they can
do to help prevent and manage OA in
practice. For example how to walk a
dog correctly! Nurses can have a big
role in teaching the dog and owner
how to do this.

“Lifestyle management of the
patient is key at all stages of the
condition, for example where and in
what the animal sleeps, how they get in
and out of the car, and the size and
shape of the area they travel within the
car. Nurses can assess all of this before
giving recommendations to the owner,”
added Mrs Davies.

On-going management and

Delegates were reminded that OA
treatment requires a combined
approach. Amanda Sutton of Suttons
Animal Physiotherapy, Winchester,
believes that long-term NSAID therapy
works best when combined with other
management strategies. “Drugs should
be just part of the veterinary
prescription. A holistic ‘team’ approach
is imperative for continued
management of OA.”

Kate Rew of Linhay Veterinary
Rehabilitation in Devon noted that
whilst the range of management and
treatment options must be discussed
with the client, it is difficult to do this
in a five-minute consult. “This is where
the VN clinics really come into their
own. It is really important to monitor
progress and, therefore, keep the dog
coming into the practice.”

Mike Hollywood of The George
Veterinary Hospital in Wiltshire
believes that the first step is to find the
right drug treatment and, once the
desired response has been achieved,
then start a management regime
including a focus on nutrition and
exercise. “This way it is clear what
effect the drug is having. Once that has
been recorded, other supporting elements of the regime can be put in

In summary, Mark Riggs believes
that there are huge opportunities for
vets to make better use of their VNs
when managing the OA client.
“Complete care plans which involve
the VN are a great way to maintain
continuity of care and cement loyalty.”

Mike Hollywood suggested, for
example, that weight clinics could be
re-branded to “mobility clinics” and
should be started as early as possible in
the OA management regime.

1. Johnston, S. A. (1997) Osteoarthritis:
joint anatomy, physiology and pathobiology.
Vet Clin North Am Small Anim Pract 27:

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