Dr. Whit Cothern is the former managing partner of Orchard Park Animal Hospital in White House, Tennessee. He previously held sales or veterinary relations positions with Boehringer Ingelheim Animal Health, Novartis Animal Health US and Scil Animal Care Co. He was a clinical veterinarian in Tennessee and Florida after he graduated from the University of Tennessee College of Veterinary Medicine.Read Articles Written by Whit Cothern
Never in my life as a practice owner or technical services veterinarian did I or any of my fellow doctors say, “Doggone it, I diagnosed osteoarthritis too soon.” If anything, the opposite happened. By the time clients mentioned that their dogs were having trouble getting up, the cartilage was long gone.
Recently, I spoke with a couple of very smart individuals about the early diagnosis of joint disease and how the benefits to the patient, client and clinic are crystal clear. I’m not in practice since I sold my veterinary clinic, so I can’t apply their suggestions in my hospital, but I’ll pass along five ideas. I’m confident that dogs and clients who visit your exam room will benefit, and so will your practice.
Start With Puppies
This recommendation is the top thing I would do differently and is what, I think, most practices aren’t doing. With large dogs and at-risk breeds, we need to bring up osteoarthritis as early as the fourth vaccination visit, when the puppy is around 16 weeks old. The clients might be surprised to find out that what they consider an “old dog problem” affects many pets in their first, second or third year of life.
Denis Marcellin-Little, DEDV, DACVS, DECVS, DACVSMR, a professor of orthopedic surgery at the University of California, Davis, School of Veterinary Medicine, has made the early conversation a huge point of emphasis.
“The majority of dogs with OA fly under the radar until they’re adults or older, and we lose an opportunity to positively impact their futures by diagnosing them too late,” he told me. “We do a much better job protecting what we have rather than trying to regain what we have lost.”
When we begin the conversation with owners of at-risk dogs early in the pet’s life, we can educate them about the subtle signs to look for and discuss lifestyle factors such as exercise and maintaining proper weight. With extremely high-risk breeds, we can talk about taking radiographs at 6 months or a year old to establish a baseline for use throughout the dog’s life.
“This starts a long-term relationship with owners that positively affects dogs’ lives,” Dr. Marcellin-Little said.
Use Tools to Detect Disease
David Dycus, DVM, MS, CCRP, DACVS, the medical director at Nexus Veterinary Specialists in Baltimore, clued me in to a screening tool that he uses and which I suggest clinicians implement immediately. You might have heard of the Canine Brief Pain Inventory (CBPI), which was developed by Dorothy Cimino Brown, DVM, MS, DACVS, at the University of Pennsylvania.
The CBPI is a brief questionnaire that asks clients to score their pets’ pain level at its worst during the past week, at its best and on the day of the visit, along with the effects of the pain on the pet’s daily activities. Clients can fill out the questionnaire or provide answers to a team member before the veterinarian enters the exam room. Then, if the results indicate the possibility of OA, the veterinarian can explore further, incorporating a thorough orthopedic examination into the visit. (Go to bit.ly/3ht5Qrq for more information.)
Joint health specialists also recommend that veterinarians use the Canine OsteoArthritis Staging Tool (COAST), another valuable resource for evaluating OA in dogs. COAST is a research-validated, systematic approach to collecting objective data related to OA risk. Used in conjunction with either the CBPI or the COAST Client Questionnaire, it incorporates client feedback and guides the veterinarian in grading each joint on pain, range of motion and radiographic results. The findings are used to calculate a score reflecting the disease’s severity. The sooner a veterinarian starts assigning COAST scores to patients, the better chance of getting ahead of OA. (Learn more at bit.ly/3qGGMl5.)
Leverage Your Technicians
When it comes to OA, veterinary technicians are perfectly positioned to do the bulk of the pre- and post-diagnosis work. They can walk clients through the pet owner questionnaire and help administer treatments.
The thing is, technicians want to help pets. That’s why they’re doing what they’re doing in veterinary practice. Anytime they can help a pet have a better life, they’re going to be all for it. So once you empower your technicians to help a dog with OA feel better and have a better life, I think you’ll see them get on board quickly.
Make Things Easy for Clients
A couple of years ago, the idea of a veterinary technician going out to a client’s car to administer an injection to a pet would have been unthinkable. But look at our lives in the past year; it’s exactly what we have been doing.
If I diagnosed OA in a canine patient and prescribed an injection, for example, I would tell the client the total cost of the eight-injection series and ask them to pay upfront, which encourages compliance. Then I would administer the first injection during the appointment. For the subsequent seven injections, I would make it as hassle-free to the client as possible by providing curbside service.
Here’s how it could work if an injection is prescribed: The client pulls up to the hospital and calls the clinic. The technician comes out to check on how the pet is doing and makes note of what needs to be entered in the medical record. Then, the technician gives the injection, and the client and pet go on their way.
Remember Lifetime Value
The value to your business of managing OA early in your patients’ lives is challenging to quantify because it’s mostly about trust. However, if we must speak in numeric terms, let’s consider that total client compliance with wellness care standards might equate to tens of thousands of dollars in practice income over a dog’s lifetime, according to an American Animal Hospital Association analysis from 2015.
While bringing up a gloomy topic like osteoarthritis might seem to be a downer with clients whose 16-week-old puppies are bouncing joyfully around your exam room, what you’re really doing is initiating a lifelong relationship with the owners and their pets. To use Dr. Marcellin-Little’s words, you’re telling the truth and gaining trust.
Growing that relationship will build your business, but what’s even more important is the reward of maximizing the pet’s well-being and the owner’s happiness over the animal’s lifetime. And there’s no need to put a number on that.
AT HIGHER RISK OF OA
When large- or giant-breed dogs are in your clinic, a red flag should pop up because they’re at higher risk of developing osteoarthritis. The sooner OA is diagnosed in these dogs, the greater the impact on the animals’ quality of life. Here are 14 breeds, in particular, to consider:
- Saint Bernard
- Old English sheepdog
- German shepherd
- Golden retriever
- Bernese mountain dog
- Labrador retriever
- Chow chow
- Great Dane
- American Staffordshire terrier
VetFolio, the North American Veterinary Community’s online learning platform, provides subscribers with an assortment of osteoarthritis courses. Examples include:
- “A Multimodal Approach to Osteoarthritis,” with Dr. Patrice Mich, bit.ly/3dCQNKJ
- Acute and Chronic Pain: What’s the Connection?” with Dr. Sheilah Robertson, bit.ly/3yiyZfL
- “Diagnosing Osteoarthritis Pain in the Cat,” with Dr. Duncan Lascelles, bit.ly/36bvtHW
- “Osteoarthritis: Early Recognition and Treatment Are Key,” with Dr. Darryl Millis, bit.ly/3yjwDx6
- “Elbow Osteoarthritis Medical Management and Laser Light Therapy,” with Dr. Andrea Looney, bit.ly/3hssi3T