Ideally, a diagnosis begins long before the veterinarian steps into the exam room. For example, it might start with a phone call reporting that a cat is urinating outside the litter box or that a dog is vomiting. Or it might kick off with information that the pet owner provides upon arrival. Whatever the details, they guide the entire visit, allowing the veterinary team to reach an accurate diagnosis. But what happens when clients have no idea that their pets have a serious health condition?
Such a scenario is common, particularly when the pet suffers from an early degenerative joint condition. A dog with cranial cruciate ligament disease, for example, often displays subtle signs that the owner mistakes for behavioral or aging issues and dismisses as having little bearing on overall health.
EDITOR’S NOTE
This article is the first of a three-part series focusing on joint health and client education and is brought to you by clinically proven Rejensa® joint care chews.
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Tamara Grubb, DVM, Ph.D., DACVAA, the president-elect of the International Veterinary Academy of Pain Management, emphasized that clients often don’t recognize signs of pain.
“Unfortunately, owners see their pet slowing down, and they think it’s just age,” said Dr. Grubb, an adjunctive professor of anesthesia and analgesia at the Washington State University College of Veterinary Medicine. “In fairness to the owners, if they never had a painful pet, how would they know their pet is in pain?”
Pets with early degenerative joint conditions are primed for the development of osteoarthritis. However, a well-trained veterinary team can significantly improve an animal’s long-term health and mobility by intervening quickly to manage the disease’s progression.
Denis Marcellin-Little, DEDV, DACVS, DECVSC, ACVSMR, said every team member plays an essential role in detecting osteoarthritis as early as possible.
“The entire veterinary team has to be a detector of signs because the more eyes that are looking at a pet, the more sensitive the team will be as a whole,” said Dr. Marcellin-Little, a professor of orthopedic surgery at the University of California, Davis, School of Veterinary Medicine. “The receptionist might see things a vet may not see because a dog is being interacted with in different ways or doing certain things in the waiting room. You really have to have eyes on the pet at all times.”
Documenting a thorough patient history provides a critical opportunity to unearth details that can help the veterinarian reach an accurate joint disease diagnosis. But asking the right questions and pulling out pertinent clues is a skill that requires training and practice. Follow these five steps to help your team recognize signs of joint disease during the patient history so that the doctor can make an early diagnosis.
1. Teach Pain Awareness
Recognizing signs of joint pain, such as difficulty rising, walking slowly, an abnormal posture and being reluctant to step onto a weight scale, can alert your team to early joint issues and guide patient history questions. Without proper training, however, team members will not know how to identify subtle signs of joint disease. In addition, keep in mind that some team members, particularly veterinary assistants, come to your practice as naive pet owners.
“We think our whole team knows what pain looks like, but how could they if they have not been involved with pets in pain?” Dr. Grubb said. “Teaching them about mobility and behavior changes to watch for and providing training so that they know what to say is critical.”
The team training might involve watching contrasting videos: pets with normal mobility and those with joint disease. In addition, educational articles, websites and prerecorded webinars can be helpful. After the initial training, pair new staff members with seasoned employees for one-on-one exam room coaching. Also, make sure the education is included in every new hire’s onboarding so that the entire team is prepared to recognize joint disease.
2. Highlight Risk Factors
Just like you should ask clients about signs of back problems in their dachshunds, seeing a pet at high risk of joint disease should trigger specific history questions. However, while veterinarians can rattle off a list of pets at risk of joint disease, your front desk staff, assistants and veterinary technicians might not know how to recognize those pets. Ensure your entire team is aware that further questioning might be warranted with these animals:
- Overweight pets
- Large-breed dogs
- Active dogs
- Sporting dogs
- Spayed or neutered pets
- Aging pets
3. Ask the Right Questions
Once your team members can identify at-risk pets, they need to know which questions can lead to an accurate diagnosis. (See “The Devil’s in the Details.”) The right questions also can help clients begin to see their pet’s behavior as abnormal, preparing them for further discussion and diagnostics.
“The support staff that sees the pet first and talks to the owner first often guides the trajectory of the rest of the visit,” Dr. Grubb said. “So, by starting with the right questions to the owner about what’s going on with the pet and by preparing the owner for diagnoses that might be made, the veterinarian is set up to walk into the room and say, ‘OK, my nurse says your dog is doing these things. Let’s start there and talk about why your dog might be doing that.’”
4. Prepare for Difficult Discussions
Conversations about joint health naturally lead to difficult topics such as weight loss and exercise. Unfortunately, some team members leave the subjects for the veterinarian to tackle. However, preparing your team to raise sensitive matters tactfully can increase the team’s efficiency and prepare the pet owner for an in-depth discussion with the veterinarian.
The key to engaging in difficult discussions is to be respectful and helpful, Dr. Grubb said.
“Pet owners need education and guidance,” she said. “They probably heard before that their dog is overweight, but they don’t know how to fix it. So, be respectful in saying that their dog is in pain. For a lot of owners, that’s the first they have heard or thought about their pet being painful. For many, it’s distressing because they don’t want their pet to be in pain, and they may think it’s their fault.”
Dr. Marcellin-Little said challenging conversations are more successful when team members tailor the message to the pet owner.
“You’ve got to understand who you are dealing with and adapt your approach accordingly,” he said. “Having a highly adaptable message regarding format and content is important for success. It’s more of a negotiation — if you can sell a car, you can sell weight loss. It’s the same idea.”
5. Establish Internal Communication Protocols
An efficient team should work like a well-oiled machine, with communication processes clearly outlined. If the patient history leads a team member to think a pet might have joint disease, pass pertinent information to the veterinarian for further questions and diagnostics. Decide as a team the easiest and most efficient way to relay the information, such as:
- Using a formal questionnaire or scoring system that is handed to the veterinarian before the doctor enters the exam room.
- Using a particular color font or highlight to call out critical details in the digital medical record.
- Applying a specific sticker to paper charts.
Most importantly, ensure the message is consistent so the veterinarian knows what the communication means precisely.
A team approach to joint health allows every member of your team to clearly see their role in helping pets enjoy improved health and mobility. As a result, they will gain confidence in their ability to spot painful conditions and feel more valued.
“The genuine enthusiasm you have as a practice owner in helping your patients with osteoarthritis will be contagious,” Dr. Marcellin-Little said. “If the energy is coming from the owner, it’s going to succeed.”
THE DEVIL’S IN THE DETAILS
Veterinary team members must be able to recognize changes in a pet’s behavior that could indicate a joint problem. The following questions asked during a wellness exam can help the team identify and address joint health issues and other painful conditions.
- Does your pet rise slowly from a sitting or lying position?
- Does your pet limp or seem stiff after exercise?
- Does your pet lag behind on walks?
- Does your pet no longer want to play or go on walks?
- Does your pet walk differently than it once did?
- Has your pet’s toileting habits changed, such as your cat not using the litter box or your dog suddenly having accidents inside the house?
- Has your pet’s posture changed?
- Is your pet hesitant to jump onto furniture or into the car?
- Does your pet have difficulty climbing stairs?
- Does your pet seem irritable or aggressive?
- Does your previously social pet now hide from people or other pets?
- Does your pet avoid being touched or petted?
- Does your pet have a hard time getting comfortable when lying down?
- Does your pet favor one side?
- Does your pet vocalize when touched in a specific area?
- Have you noticed any other behavioral changes that might indicate pain?