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‘Huge opportunities’ for VNs in managing OA

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01 March 2010, at 12:00a.m.

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 condition?

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 animal.”

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 changes.

“Many clients think that the dog is just getting ‘old’, whereas 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 intermittent.

“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 treatment 

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 place.”

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: 699-723.