Samantha Lindley BVSc MRCVS
Samantha qualified from Bristol Veterinary School in 1988 and interned as Large Animal House Physician at Glasgow Veterinary School, before going into mixed practice in South West Scotland. In 1993 she became veterinary consultant at Dr Roger Mugford’s Animal Behaviour Centre, developing an interest in the clinical causes of behavioural problems, especially pain, as well as developing a veterinary acupuncture practice.
Since 1994, she has been involved in the assessment of numerous legal cases, both civil and criminal, and especially the Dangerous Dogs Act 1991; preparation of legal reports; and court appearances as an expert witness. Samantha is the founder of Longview Veterinary Services, a team of consultants who, between them, run the Pain and Rehabilitation Service and the Behaviour Service at Glasgow Veterinary School; the Pain Clinic at the Dick Vet School (Edinburgh) and a Pain clinic at Broadleys Veterinary Hospital in Stirling, as well as behaviour and training services across Scotland and the North of England. Longview CPD offers high quality CPD to veterinary professionals.
Samantha teaches veterinary undergraduates behavioural medicine; over 70 veterinary surgeons and nurses a year the scientific approach to veterinary acupuncture; lectures widely on the subject of behaviour, pain management and acupuncture; and has an additional special interest in the welfare of captive wild animals. “Essentials of Western Veterinary Acupuncture”, commissioned by Blackwells and written by Samantha and Dr Mike Cummings was published in 2006. Samantha is a contributor to the BSAVA Manual of Canine and Feline Behavioural Medicine. The BSAVA Manual of Canine and Feline Rehabilitation, Palliative and Supportive Care, which Samantha co-edited with Penny Watson, was published in September 2010.
Sam kindly agreed to answer the following questions:
What are your feelings on how we currently manage arthritis in dogs?
We do a much better job now than when I first qualified because we understand the disease better and have a wider range of techniques with which to tackle it. However, I think we struggle to keep owners on board with treatment and need to offer an individualized approach taking into account what it best for each patient and also what will keep the owner working with the practice.
As a consultant in chronic pain management what do you feel is essential for managing canine arthritis effectively?
There are many aspects to this.
First, it is important that owners understand that young dogs get arthritis and why it happens (and that it is not their fault). There is often understandable shock and, to some degree, denial in discovering that a young dog could suffer from something that we, as humans, perceive as a disease of old age. This is because, in humans, arthritis is usually caused by wear and tear on a joint that starts life as normal and healthy, whereas in dogs it is caused by wear and tear on a joint that is already abnormal, and may additionally be unstable and/or prone to microfractures and intrarticular joint fragments.
Secondly, we must learn to identify and assess the presence of pain early. Dogs adapt to their pain and discomfort by subtly altering their behaviour and physical movements. Often, we humans see the alteration of behaviour in a young animal as signs that they are maturing and, later, that they are “getting old”. Too often, more obvious changes in behaviour become ‘behaviour problems’ and are misdiagnosed with vague labels such as “fear aggression” or “anxiety disorder” where the painful cause of the anxiety is missed. Missing these early signs of pain means that it is very likely that the pain gets “out of control” and is much harder to treat later on.
The assessment of chronic pain by palpation (examination) and of suffering (how miserable the pain makes you feel) by discussion of the dog’s behavioural changes or habits needs to be more widely taught in the veterinary profession. These are not skills we are given at veterinary school and we all need to understand that chronic pain is a very different beast from acute pain, and that the suffering caused by arthritis is not limited to what is going on in the diseased joint.
Once the owner understands the disease, we can give them the tools to manage it effectively: the right level of pain relief for their pet (as an individual); weight control (which really means reducing fat); making sure that for all the resources we limit (play, exercise, food) and that are limited by the disease (play, company, comfort) we replace them as best we can; and the sensible control of exercise.
Once we, the veterinary professionals, understand the degree of suffering of our individual patient (and this can include restriction of resources and frustration), we can tailor our treatment accordingly.
Finally, it should be understood, by all those involved, that the management of arthritis is a dynamic process that can be individualized and then modified as the condition and needs of the patient change and progress.
How do you see treatment options for arthritis progressing over the next ten years?
We are all still searching for the “holy grail” of arthritis management or treatment. The main focus is always on the new and the exciting: intra articular treatments and better joint replacements. The former are important and need to be explored fully as to their specific effects, i.e. over above an unusual interaction with a joint and all the subsequent attention (laser, physiotherapy etc). The latter will always be invaluable for those patients whose joints are no longer functional.
But such approaches are currently expensive, and are currently available to the dogs belonging to the well off or the insured. It costs relatively little to identify problems early and to treat well and conscientiously in order to limit the need for such therapies.
Let us not forget the basics in our race for the spectacular.
If you could have the opportunity to give one tip/ piece of advice to an owner with a dog suffering from arthritis what would it be?
You know your dog: don’t be afraid to ask for more help if you think your dog is struggling with its arthritis, or even if you just don’t know. There are chronic pain clinics in many areas now and their job is to assess as well as to treat. It isn’t all about drugs – you may be very pleasantly surprised about how positive the management of arthritis can be.