age, breed, history, and other signalment and risk factors, preplan and include orthopedic screening and monitoring radiographs into each predisposed pet's long‐term care plan (see 1.3 Personalized Care Plans). Be especially forthcoming in your recommendations for these radiographs in pets that fit any of the following criteria.Overweight or obesePredisposed breedWorking dog or athletePets that are exhibiting behavioral changes, including new aggression, decreased interaction with clients, and those exhibiting new noise aversions [5]Cats with inappropriate toileting
So long as they are stable, take advantage of any pet sedated or anesthetized for procedures (e.g., spay/neuter, dental prophylaxes, ear cleanings, laceration repairs, etc.) to do a deeper, more thorough palpation and ROM testing of joints. Since it's good practice for you and also may turn up otherwise undiagnosed conditions (providing better medicine and improving comfort for your patients, and revenue generation for your practice), do these deeper orthopedic evaluations as value‐added, no‐charge components of your sedated/anesthetized procedures on all patients. However, be sure to include a section on your estimates and sedation/anesthesia consent forms offering and recommending that, so long as their pet is stable under sedation/anesthesia and based on your findings and their pet's risk factors, specific orthopedic radiographs may be recommended. Provide an estimate for such and get the owner's authorization for such in advance.
Dr X loved orthopedics and made it a habit of practicing his drawer testing on anesthetized patients. Max, a 5‐year‐old neutered male Labrador, was in for dental prophylaxis. While Max was under anesthesia for his dental, Dr X thought he appreciated a little more laxity in Max's right stifle. He contacted Max's owner to report his concerns and recommend stifle radiographs. The owner had been advised of this possibility prior to the procedure, based on Max's breed predisposition, and consented. The radiographs were sent off for interpretation and a partial cruciate tear was suspected based on the clinical history, physical exam findings, and radiographic appearance of Max's stifles. Max's owners were counseled on weight management and Max was started on a daily joint supplement and fish oils. A referral was also made to a local veterinary physiotherapy center to aid in his weight loss and to help stabilize his stifles as much as possible. With this early detection and intervention, Max remained stable and never required cruciate surgery.
Whether they develop early in life or late, orthopedic disorders can cause significant pain, dysfunction, and decreased QOL for our veterinary patients, as well as significant financial, logistical, and emotional distress for our clients.
Across the board, serious orthopedic disorders are going undiagnosed and therefore untreated and managed, often to the detriment of our patients, clients, and even our own businesses.
Proactive education, screening, and appropriate interventions should be the standard of care, as they benefit all stakeholders (patients, clients, and practices).
Radiography isn't the only method available for orthopedic disease screening in veterinary patients.
Take advantage of any sedated or anesthetized pets to do additional screening for orthopedic conditions, with owner consent.
References
1 1 Breed Statistics. www.ofa.org/diseases/breed‐statistics
2 2 Mills, D. (2014). Prevalence of Osteoarthritis in Dogs Undergoing Routine Dental Prophylaxis. Presented at the World Small Animal Veterinary Association World Congress, Cape Town, South Africa, September.
3 3 University of Glasgow. Cats Do Suffer From Arthritis, Study Shows. ScienceDaily. www.sciencedaily.com/releases/2007/08/070824215618.htm
4 4 Hardie, E.M., Roe, S.C., and Martin, F.R. (2002). Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994–1997). J. Am. Vet. Med. Assoc. 220 (5): 628–632.
5 5 Lopes Fagundes, A.L., Hewison, L., McPeake, K.J. et al. (2018). Noise sensitivities in dogs: an exploration of signs in dogs with and without musculoskeletal pain using qualitative content analysis. Front. Vet. Sci. 5: 17.
Recommended Reading
1 Canine Brief Pain Inventory (Canine BPI). www.vet.upenn.edu/research/clinical‐trials‐vcic/our‐services/pennchart/cbpi‐tool
2 Hielm‐Björkman, A.K., Rita, H., and Tulamo, R.M. (2009). Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am. J. Vet. Res. 70 (6): 727–734.
3 Valentin, C. (2009). Cincinnati Orthopaedic Disability Index in canines. Australian Journal of Physiotherapy 55: 288. www.sciencedirect.com/science/article/pii/S0004951409700145.
4 Feline Musculoskeletal Pain Index. https://cvm.ncsu.edu/research/labs/clinical‐sciences/comparative‐pain‐research/labs‐comparative‐pain‐research‐clinical‐metrology‐instruments‐feline‐musculoskeletal‐pain‐index
5 Klink, M.P., Gruen, M.E., del Castillo, J. et al. (2018). Development and preliminary validity and reliability of the Montreal instrument for cat arthritis testing, for use by caretaker/owner, MI‐CAT(C), via a randomised clinical trial. Applied Animal Behaviour Science 200: 96–105. www.sciencedirect.com/science/article/abs/pii/S0168159117303271.
3.13 Breed Predisposition
Nan Boss, DVM
Best Friends Veterinary Center, Grafton, WI, USA
3.13.1 Summary
Different breeds have different predispositions to disease states caused by genetic variants. Any personalized care plan should incorporate screening, treatment plans, and client education based on susceptibility to genetic diseases. There is a large opportunity for practices to improve both patient care and professional outcomes via breed‐specific programs.
