{"id":10457,"date":"2021-08-01T00:00:55","date_gmt":"2021-08-01T00:00:55","guid":{"rendered":"https:\/\/todaysveterinarybusiness.com\/?p=10457"},"modified":"2022-06-15T17:48:03","modified_gmt":"2022-06-15T17:48:03","slug":"joint-custody-osteoarthritis","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarybusiness.com\/joint-custody-osteoarthritis\/","title":{"rendered":"Joint Custody"},"content":{"rendered":"

Never in my life as a practice owner or technical services veterinarian did I or any of my fellow doctors say, \u201cDoggone it, I diagnosed osteoarthritis too soon.\u201d If anything, the opposite happened. By the time clients mentioned that their dogs were having trouble getting up, the cartilage was long gone.<\/p>\n

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\u2019m not in practice since I sold my veterinary clinic, so I can\u2019t apply their suggestions in my hospital, but I\u2019ll pass along five ideas. I\u2019m confident that dogs and clients who visit your exam room will benefit, and so will your practice.<\/p>\n

Start With Puppies<\/h3>\n

This recommendation is the top thing I would do differently and is what, I think, most practices aren\u2019t 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 \u201cold dog problem\u201d affects many pets in their first, second or third year of life.<\/p>\n

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.<\/p>\n

\u201cThe majority of dogs with OA fly under the radar until they\u2019re adults or older, and we lose an opportunity to positively impact their futures by diagnosing them too late,\u201d he told me. \u201cWe do a much better job protecting what we have rather than trying to regain what we have lost.\u201d<\/p>\n

When we begin the conversation with owners of at-risk dogs early in the pet\u2019s 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\u2019s life.<\/p>\n

\u201cThis starts a long-term relationship with owners that positively affects dogs\u2019 lives,\u201d Dr. Marcellin-Little said.<\/p>\n

Use Tools\u00a0to Detect Disease<\/h3>\n

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.<\/p>\n

The CBPI is a brief questionnaire that asks clients to score their pets\u2019 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\u2019s 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<\/a> for more information.)<\/p>\n

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\u2019s 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<\/a>.)<\/p>\n

Leverage Your Technicians<\/h3>\n

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.<\/p>\n

The thing is, technicians want to help pets. That\u2019s why they\u2019re doing what they\u2019re doing in veterinary practice. Anytime they can help a pet have a better life, they\u2019re going to be all for it. So once you empower your technicians<\/a> to help a dog with OA feel better and have a better life, I think you\u2019ll see them get on board quickly.<\/p>\n

Make Things Easy for Clients<\/h3>\n

A couple of years ago, the idea of a veterinary technician going out to a client\u2019s car to administer an injection to a pet would have been unthinkable. But look at our lives in the past year; it\u2019s exactly what we have been doing.<\/p>\n

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.<\/p>\n

Here\u2019s 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.<\/p>\n

Remember Lifetime Value<\/h3>\n

The value to your business of managing OA early in your patients\u2019 lives is challenging to quantify because it\u2019s mostly about trust. However, if we must speak in numeric terms, let\u2019s consider that total client compliance with wellness care standards might equate to tens of thousands of dollars in practice income over a dog\u2019s lifetime, according to an American Animal Hospital Association analysis from 2015.<\/p>\n

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\u2019re really doing is initiating a lifelong relationship with the owners and their pets. To use Dr. Marcellin-Little\u2019s words, you\u2019re telling the truth and gaining trust.<\/p>\n

Growing that relationship will build your business, but what\u2019s even more important is the reward of maximizing the pet\u2019s well-being and the owner\u2019s happiness over the animal\u2019s lifetime. And there\u2019s no need to put a number on that.<\/p>\n

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AT HIGHER RISK OF OA<\/span><\/h3>\n

When large- or giant-breed dogs are in your clinic, a red flag should pop up because they\u2019re at higher risk of developing osteoarthritis. The sooner OA is diagnosed in these dogs, the greater the impact on the animals\u2019 quality of life. Here are 14 breeds, in particular, to consider:<\/p>\n