So, thank you very much for joining me this evening. I'd like to say a massive thank you to Webinar vet for allowing this to happen. I've got so much to cover that we're gonna just crack straight on.
So tonight I'm gonna try and leave you with 5 take home messages. I go to quite a lot of CPD myself and I end up finding I'm a bit overwhelmed, so we're gonna stick to just 5 really strong take-home messages tonight. I'd like to introduce you to my lecture assistant.
This is Todd, a bit of a funny story. Todd was originally called Food for the dog. I didn't think there was any chance that that could be a rude word, but in Scottish slang it means vagina, so his name very quickly changed to Todd.
But he's going to be featuring throughout our lecture just to try and get into your memory banks, try to leave an impression so that what we talk about tonight actually goes into your workplace tomorrow. So let's really look at the figures. 80% of dogs over the age of 8 suffer osteoarthritis.
20% of all dogs, and I think this is something that is really neglected, is it's not just a disease of the elderly. The classic picture in people's head is the old, overweight Labrador, 1011 years old. This couldn't be further from the truth.
Many of the camp followers have dogs that are 6 months to 6 years, and they're struggling to manage a painful condition. Looking at these figures, that means that 1.2 million dogs in the UK are currently suffering chronic pain.
So let's see whether tonight's webinar is relevant to you. It is, because if you're not seeing 80% of dogs 8 years and plus on your books on some form of management plan, then you're missing a trick, and the problem is running away from you. So hopefully by the end of this evening, we're gonna be able to really improve the service for your owners.
So game changer number one is we need to start catching this disease earlier. With the dog in mind, why do we want to catch it earlier? Because we need to try and start inf influence disease progression.
We know that nociceptive pain, which is the localised inflammatory pain, is easier to control than when they become centrally sensitised, which is a common consequence to uncontrolled inflammatory and peripheral pain. We also have a condition where the pain doesn't stay just within the joints affected. By weight shifting away and relieving the discomfort in their limbs, they create secondary problems.
So they compensate and create further dysfunction and pain elsewhere. We also have to think about that they create coping strategies. And I think a thing that breaks my heart a lot is hearing stories of older dogs that have learned to become snappy or they're anti-social or they don't tolerate other dogs.
So these are learned behaviour patterns to cope with the pain that they're enduring. And also think about the associated comorbidities. We've seen acute moist dermatitis with dogs that are chewing themselves because of pins and needles or sharp burning pain or the throbbing around an uncomfortable joint.
I've also seen dogs that have repeated urinary tract infections because it's too uncomfortable to wee, so they actually hold their urine and end up getting second infections. For the owner, catching it early is gonna give us more opportunities. I would much prefer to be seeing a dog that still had good muscle mass, were reasonably well balanced, hadn't developed a load of behavioural consequences, and I would rather be and have a conversation about them getting a dog's weight correct, stopping unnecessary lifestyles that were influencing the disease, then putting them onto a strong cocktail of drugs.
Financially, it makes better sense to catch this earlier. I know I prefer to have a consult where they are paying the consultation fee and they're doing lifestyle change rather than going home with a very high bill with a a number of different drugs and interventions. We know if we catch this disease earlier, we're going to get a longer life.
We're gonna have a greater chance of a successful outcome. And something I think that is really, really often overlooked, and we see a lot on our social media, is there's a massive emotional burden that comes with this disease. And owners that end up catching this disease quite late, feel a lot of guilt for having not noticed soon enough.
And for the team, it's really imperative that we catch it early because we all do this job because we care about animals and there is a definite welfare aspect to chronic pain. We will talk about this later in the webinar. Well, for the actual veterinary team, more options, more successful outcomes, we're going to be able to manage the pain better.
I know that I would rather be dealing with a dog that has pain localised to say, the hips than a centrally sensitised dog that you can't touch. Again, we want these animals to be living longer in our care. It makes sense on a business sense, client service sense, and it leaves happy staff and happy owners.
Another aspect that the veterinary profession really is catching on to now is that there's more avenues of service provision and income if we catch this disease earlier. So something that's really exciting is the idea of senior dog groups involving hobbies connected to the practise, so scenting activities, you know, hoopers, which is a low impact, agility. There's lots and lots of different avenues that the practise can offer service to their clients.
So how do we catch it early? This is called CAm factor, so anybody that's seen CAM doing lectures, we get our arms up and we're pretending to do the X factor and we twist it 45 degrees, go, no, it's cam factor. This is a really good way of trying to persuade yourself to convince yourself that you can say something to an owner that's in your care.
You've seen a dog that's walked in and you have that feeling that it's carrying chronic pain, what can you do in your mind to make sure you're convinced that your, your, your hunch is correct? So we're gonna just work our way through this. Behaviour change, postural change, muscular changes, capability and gait changes.
So we do have a tendency to wait until we have overt signs of pain, such as limping, such as vocalising, and this is something that's really a big problem within the public is they really do not understand the difference between acute pain and chronic pain. And my big tip to you is to talk about it. It's cos once they understand that acute pain, which is a reflexive.
Good harm is the vocal pain, is the one where they're trying to reduce the discomforts. They limp, they lift their limb, they back away. Chronic pain is very different, and it's something that we learn to cope with.
So this dog is walking in an a regular way, in an uncoordinated fashion, and we see this every day. This dog isn't overtly limping, but it's got a significant gait change. Stumbling or losing balance when walking, so let's talk through this picture quickly.
Let's say that this dog has just started its walk, so we're only 5 minutes in and it's already panting. Is that a sign of discomfort? Is that a coping mechanism?
We've got a very thick maine there, so we've got weight shifting into the fore quarters, and we've got therefore soft tissue change which has affected the coat changes above. We've got a quite a high raised you right for limb there. Is that because we've got compensatory change into the shoulder girdles, so therefore, we've got restricted scapular movement across the thoracic wall, which means that this dog to actually protract its limb and do ground clearance, it's having to do an exaggerated lift.
We've got definite changes in the back limbs because we've got almost a crisscross here. This dog is potentially slightly attaxic, propriceptive deficits, weak, hasn't managed to deal with what's quite an easy terrain, and the tail's counterbalancing. So there's a lot going on in this picture, saying that there's underlying problems.
Changings in the willingness to interact. The dog that used to greet you at the front door, the dog that used to enjoy spending time with the family, now tends to be distant, tends to keep themselves to themselves. Is this dog actually alloymic?
Is this dog actually suffering quite a degree of pain it doesn't want to be touched, doesn't want to be brushed past, doesn't want to have the other dog in the household nudge it because it might lose its balance. Seeming uninterested and distance, again, the dog that used to be the, you know, the life and soul of the party now takes itself away and it's excluding itself from the the family community. Sitting in a strange way with effort to stand up.
So let's look at this dog. It has got one eye, so don't worry, it's not a trick photo. But this dog's back legs look like a deflated tyre.
It's got no hamstring mass there. It's completely back on its haunches, and you can imagine that it's having to use its four quarters and it's power through its neck to to drive it into a stand because it's got no strength in the back legs to push it forward. And this is what my dog used to do.
She used to choose a sleeping position that would offer relief, so she had a lumbosacral disease and the the spinal nerve pinching in the L7 S1 region, this offered her relief so that she could actually relax. So changes in the way that they, they sleep. A common one that we hear of are dogs that have begun to circle before they lay down.
Is that them prepping? Is that them hesitant because they know the act of going from a stand to delay is going to incur some pain. So subtle things, and this one, as I say, breaks my heart.
The family dog that's now become a little bit snarly has has snapped, is intolerant of the dogs in the park, doesn't like guests. Is that because that dog is uncomfortable? So let's go back to the calm factor.
Behavioural change, quite often that's one of the earliest signs, because we have amazing coping strategies, as do dogs. Postural changes as they start to compensate and shift the weight away from the problematic limbs or limb or limbs. With postural change over time comes muscular changes.
So if a leg is not bearing the weight that it should do and it's transferring weight to the the other limb, the ipsilateral limb, have we, the contralateral limb, have we got, muscle development and muscle wastage? And with that will eventually come capability and gate change. That's when you start to see them hesitating and getting into the car, stumbling on walks.
So by waiting until we have overt physical change, that's quite a long time down that route, and throughout this time, the dog has been in pain. So here are some tips to try and help you with your game changer number one. Prime your client base.
You know this is a discussion that we can be having at a lot younger age. This could be included in puppy parties. This is something that the practise can be saying to owners, this is really common, and the sooner we catch it, the better the outcomes.
So it doesn't matter what age your dog. If you're seeing these things, flag it up to us, we're here to help. What about for your routine consults, send out a preceding questionnaire.
Ask them, you know, how is your dog's mobility? Have you seen behavioural changes? Is he showing signs of slowing down?
Make use of your nurses, get them to be doing in their senior health clinics. Remember to listen to the weird stuff. I can remember looking back and thinking how many cases have I missed and hundreds.
People that say, oh, he doesn't wag his tail so much anymore. His ears are down a lot, or, you know, he every now and then catches a toe. And that was my opportunity to say, let me have a look, there could be something underlying this.
Watch them walk in from the car park, watch them walk in from the waiting room and ask the owner to bring video clips in. Something that's really quite novel, it's a stance analyzer. It's about the same size as the average weighing scales, and it looks at weight carriage.
So, we would ideally want a dog to have 30% on each for imb, 20% on each hind limb, and it's a machine that you can actually start showing known as black and white figures of weight shift. So it's a really good tool to have. Remember to ask leading questions.
So I often say to people, so any signs of slowing down? So you say it in a positive way, and when they say, yeah, yeah, yeah, he's really starting to show his age, it gives me a window of opportunity to talk to them that actually that could be pain. And don't forget to look for these physical signs.
So look for the subtlety. Start your examination with a pain exam. That's history taking and that's just a light touch looking for the dog's response to your presence and you touching different parts of their body, looking for the white of the eye, the ears to go back, slightly stepping away, the skin crawls, the flinch.
Then proceed on with your clinical exam, so looking at heart, ears, abdomen. Then go on to your neurological exam looking for peripheral nerve deficits. And then finally go to your orthopaedic exam, because that is quite an involved, that's quite a mechanical exam.
Remember that dogs can be very stoic. It is one of their behavioural coping strategies, so look for the subtlety, holding of the breath, the whites of the eyes, flicking back looking at you. So game changer #2, team approach.
I was just saying to Richard before this that I, I thought there was a small hope that I could finally be good at just one thing. I thought I'd just pick one disease, and I'll know it inside out and backwards. I don't.
It's huge. It's an extremely complex, involved disease to manage properly, and you need a team. In the current consult system that we have in first opinion practise, which is 10 to 15 minutes, it is impossible to offer a chronic pain consult in such limited time in such a high stress environment.
Make use of your team. Your team have different skill bases, it might be their better communicators, they might listen more, but they also might bring something else, such as massage, physiotherapy, hydrotherapy. So also consider that by employing different members of your team, you are providing the owner more time.
And this is really, really important because this disease is a long one. We're not just treating the dog, we're treating the caregiver because the caregiver's essential. And if they need to talk and they want to ask you questions that they feel a little bit embarrassed about, you need to be giving them time because these clients will bond to you and to your practise for the long term.
So just to prove my point, we have a number of platforms online. Holly's Army is one of the ones I'm most fond of, and these are some of the things that our followers, our Holly's Army followers have said. They want this service.
They feel that their, their vets can provide them more. A specific OA clinic. They want to go to people that are knowledgeable about osteoarthritis and all management avenues, and they want to be talking to somebody that really finds it an interesting topic because it's important to them.
They're watching their dog, potentially in discomfort for 12 hours a day, fretting about it. They want to talk to somebody that cares. Think about the environment that you've got these dogs in, you know, anti-slip floor, we're we're saying to these owners, consider the environment at home.
Get rid of your slippery floors. Are we actually leading by example, and I don't think we are. And I do question how many dogs are in fear of coming into the practise because they've potentially slipped on our flooring during a previous visit, and it has caused an acute pain response to which they've now associated that practise with that pain.
You don't know, but I am, there's many people that agree with the same thinking. Do we need to be looking at the environment and we certainly need to be leading by example. I would love for our vets to have a clinic for owners with dogs who have arthritis.
It is wanted. So this is a very interesting topic, sensitive to the needs of nervous or reactive dogs. So, behaviour change connected with pain, yes, definitely.
So this is from the University of Lincoln and Professor Daniel Mills's team. They've done a study where they're looking at noise sensitivities, and they certainly found that musculoskeletal disease was linked in dogs that developed noise phobias at a later stage in life. And the theory behind it is when hearing a loud bang or an unexpected noise, the muscles tense, they, they jar themselves and it creates an acute pain experience.
So then the noise becomes associated with the pain. So in summary, there is scope for us to be doing a lot more dedicated RA clinics, environmental considerations, questionnaires, written summaries, and all dog groups, considered handling techniques and owner encouragement. There's plenty more that is available for us to be doing.
So this team, we need to have a team approach to managing this disease, and these are a few players within your OA team. So obviously we've got the vet, we've also got the vet nurse who can do the clinics, they've got to adjust their handling skills because this dog has potentially got pain. And they're gonna coordinate the management plan.
We've got receptionists, they're your eyes and their ears. They're the people that owners confide into. They're the ones that are gonna get the first hints that that dog's behaviour or lifestyle has changed, could a pain be underlying it.
External therapists, people are looking for alternatives, and it is our responsibility to be sending them into the safe direction. Do you have a directory of external therapists that are well qualified that you know that write reports, they get referral forms that you can send your client base to? Do you have a directory sat there in the waiting room?
Specialists, many, many specialist centres now provide chronic pain clinics, and they're available for phone advice. I know certainly that Gwen Covey Crump from Langford Vets is very keen to take your call, so don't be scared to ask their advice. And the owner, if we See a dog for 15 minutes every 3 months, which would be our gold standard plan.
That means that we only see that dog for 0.0023% of its life. The owner is the key instrument to making this plan work.
And then can. We're available 24/7, 365 for online advice. So all of the team can play a role, and we're gonna skip through this quite quickly because time is limited tonight.
But this graph just demonstrates that every part of the team plays a role in the five stages of arthritis. Which are identification, stage 2 diagnosis, stage 3 initial plan, stage 4 management plan, and stage 5 end of life care. So everybody in your team can play a significant role.
We believe in the CAM 0A 18, and we believe that by having a nurse, receptionist and vet all passionate about chronic pain management, arthritis management, you're gonna be able to provide a gold standard service because they all bring skills to the to the table. The client features in the team. Instructing them, advising them and educating them is absolutely imperative.
Just a little bit of a big me up about CAM. We do offer practise training. It's something that we absolutely love doing.
We come to your practise, we spend the day with you, you remain open, but we take your team in stages, reception first for an hour and a half, nurses 1 hour and a half, team and 1 hour and a half, that's 2 hours, so that you're all singing from the same song sheet with the same level of enthusiasm, with the same understanding, ready to create your OA clinic the next day. So if you want any more details, please do just get in touch with me at info@ canine arthritis.co.uk.
Details at the end of the lecture. So game changer number 3, we need to be leaving these owners with visual structure because it's quite scary how little information goes home. So this was from the Journal of the Royal Society of Medicine, a patient's memory for Medical Information and be shocked, 40 to 80% of medical information provided by the healthcare practitioner is forgotten immediately.
The greater the amount of information represented, the lower the proportion correctly recalled. This is so upsetting, especially when you're a personality type like me that tries to give the owner everything they could need. So we need to be thinking about how can we ensure the information that we give them and go on with them, and they can review it.
So we totally, totally believe written word is important overspoken. So all of that advice gone. What are we gonna do about it?
Well, we need to be thinking more seriously about it because this is what happens. And for any vets that have been out on the forums online, be it Facebook, be it wherever, whichever platform, it's terrifying. All of this advice is being plucked out of thin air for a dog that they've never seen an owner they don't know, and I personally find it terrifying.
But the reason people are going there. It's because they want help, and a lot of the owners of arthritic dogs are vulnerable, and they want to make their dog's pain go away, and they will go to any lengths to do so. And going on your iPad, sat in front of the TV on a Friday night is a very easy way to start trying to collect information.
We need to be aware of this. It's a little bit of a tangent time with the lovely Ryan Reynolds. I want to propose that it isn't that owners.
Don't want our intervention, we've got to be aware about where they are putting their energies, their finances, etc. So we did a little survey a few months ago, this is the lovely Luna, and we asked the CA followers, what are you spending your money on? In one month, what do you spend your money on?
Everything, let's consider everything. And it was fascinating because many people came back and realised that they spent more money on the alternatives, the complimentary, than they do on the vet fees. And the vets are always getting the bad press that they're very expensive, but when you actually look at what people are investing on their dog, there's a massive outlay on non-evidence based approaches.
So we have a magnetic collar over here. There is no evidence to suggest static magnets offer any relief. We've got a variety of supplements on this one.
Till today, there is no evidence that turmeric can offer pain relief. The study done by John Innes showed no beneficial effect. I find it an interesting area.
It's not, not for a topic today because there are so many believers, but currently it's still very weak. CBDR, we can't even go there, but people are spending money on it left, right and centre. So we do need to be aware that people are investing in this disease management.
But money is finance, so we need to be making sure that they are investing their energy, their finances, their time into appropriate means. See, just a few of the, the truthful comedies, people do move house. I know that Fiona from Hills, she moved house because her dog couldn't do with stairs.
Owners are very committed to looking after their lifelong companion. So just be aware that the finances are finance and people are investing it, but are we, the vets doing enough? So I did a little survey for you guys.
I went online, I went on to a well, well recognised online pharmacy and I typed in arthritis, and I got 283 results. So I'm on my iPad. It's a Friday night.
I'm watching TV and I'm desperate for an intervention. And all manner of things come up. And none of these products have any evidence base behind them.
But they're easy to purchase, they're affordable. We do as a profession need to start thinking in more detail of what we can offer our clients. So let's give them structure.
So this is all about them having structure to make sure that they know that they're doing everything that they can for their dog, and they don't go onto their iPad on a Friday night and just randomly start buying different supplements that have no evidence of effect. This is multimodal management of arthritis. We've obviously got surgery to play here and where I'm working now in regenerative medicine.
So talking about structure, I want to just show you something that we're up to, and it's, it's really quite novel, and I'm really quite excited about it. Peer to peer learning. We all know those cases where somebody comes in and they brought their dog in and they say, Oh, Muriel, the lady that walks around the park, her dog's been taking this, and it's been mind-blowing.
So I've decided to go and buy him 6 months' worth and blah blah, blah blah blah. Peer to peer learning is very, very powerful, peer to peer influence. So let's harness that.
This is Holly's army. This is a newbie who's just arrived. They're very worried about their dog.
They don't know what to do. This is one of our followers. She is a ambassador, so she's had extra training.
She immediately steps in and she provides structure. So that owner doesn't immediately go and start purchasing things in our evidence base. They know how to structure a management plan.
They know what is important. They can tick their boxes and feel that they have satisfied a good management plan. So, crack on Ambassadors.
Tang to time number 2 with the loveless Tom Hardy. Please, let's not forget how powerful online is. A lot of practises are now investing more time in their social media, but this, I just want to demonstrate what can be achieved with, information dissemination.
So we managed to get an article into the Sunday Express, and I put it onto our Facebook page, and oh my goodness, it went nuts. We had 1500 shares within around about 48 hours. 656 comments.
So this message, and I still hold by what I feel is that these throwing devices are just creating massive joint soft tissue problems. And it caused quite a stir, but it's certainly got the message out there, and Danny on the team was on the radio, I was being interviewed by a TV station in America. Online is a very powerful way for us to get the message out.
So back to structure, we need to be giving them these diagrams so they can picture in their mind and tick off what they have done and they can therefore sleep easy. This is totally printable, laminate, stick it in your consult room, stick it in your nurse clinic, even stick it at the front desk in reception, along with the cam factctor sign. So your receptionist can also be part of the early identification.
So lifestyle changes. I'm so passionate about this because it answers so many problems that we currently have in our vet industry where owners really expect to just go out with bills. This is a game changer and it's free of charge.
So lifestyle changes are often overlooked poor time allocation to this intervention. There's very little understanding of the importance to owners cos dogs cope and dog owners are waiting for groans, yelps, limping. So the fact that their dog is still walking on that slippery floor, they think it can't be a problem because they don't understand that dogs cope as we do.
It's a fundamental part of human OA management and the technical term is called joint protection. So let's go through a few cases. This is Monty, Monty's a 9 year old German shorthaired pointer, and Monty was on the books to have an elbow replacement for uncontrolled elbow pain.
So Monty's mom had spent quite a lot of money looking at many different therapies. And they were, as I say, just about to go for the full blown elbow replacement. I, by chance, did a house visit, and as I knocked on the door, I heard.
And this dog had come flying down two flights of stairs, hit the tiles, had to turn sharply because there was a wall, 2 ft in front of the last stair. That is going to create a huge amount of impact and torsional forces through that elbow. This dog that was on rest was not resting.
Just so you know, with regards to elbow replacements, these are two papers that have been released. This is from the UK. Just look at the last sentence.
24% that went under the Tate elbow arthroplasty had unacceptable outcomes, which more than likely means amputation. Just to pick up our our US colleagues, this was a two centre study and they actually had a lot lower complication rate because they had fewer surgeons that they were more practised. However, these are still high figures.
So we don't take these surgeries lightly. And if the dog has been doing the stairs, and if the dog stopped doing the stairs with the baby gates, could we actually avoid doing a major surgery? So the often forgotten piece of this multi-modal management is preventing further injury.
So let's go through case number 2. This is Lola, 12 year old female neutered boxer, belonged to Mrs. Talbot who absolutely adored her, and you could tell that because there was books all around the house with photos of Lola.
This was the coffee table in the living room. Mrs. Talbot was the county court judge, and she worked very, very long hours.
So the dog was at home and the dog walker would come in once a day, so the dog could be on it on her own from between 7 and 7 p.m. In the house, there was, here we go, going the wrong way.
A dog flat. So I'd seen her as a vet in the clinic, and the dog had severe bilateral stifle pain, and we were looking at more and more medications, adapting, changing our pharmaceutical approach. It wasn't until I did a house visit, did I see that the dog flap that had been put in when the dog was a puppy.
Was still there and being used and it wasn't until the owner said, no, no, she still copes with it, fine. Go on, Lola, go outside. And the dog took a 4 ft run up and lobbed itself through this dog flap, clipping both knees on its exits and dropping 2 ft onto a concrete floor below.
Did the owner go, Oh, so this dog didn't yelp, and it didn't limp, but this was a severe problem in the management plan. So, let's talk about less of my anecdotes and a little bit more science. Let's think about arthritis.
Now arthritis, everybody really latches onto it being a disease of the cartilage. Yes, in the beginning, but it is actually a disease of the whole joints. The soft tissues in it.
It leads to compensatory pain and is a common cause of central sensitization. We need to start thinking about this disease on a global level, not just on a focal articular level. So as a vet and a vet nurse, we tend to think very much like this.
This is our academic training. So we're looking at these different areas that pain is generated within the joint. So we've got thickening of the joint capsule, remodelling of the subcontrolled bone, we've got the inflamed synovia, we've got poor joint fluid.
We've got peripheral sensitization, we've got central sensitization. Compensation. We think very differently to the way that physios and rehabs think.
They think like this and pain is just part of it. But when you start looking at the consequences of arthritis in a dog, offloading, poor balance, changes in muscle tone, postural adjustments, altered gaits, altered proprioception. Arc of flight has changed, range of motion has changed, swing and stance phase is changed, modification of footfall, load distribution.
They're looking at this greater picture of how does this cope, this dog cope in the environment that we choose to put it in. So now let's also look at how it's a negative cycle. Poor propriception because of soft tissue loss, because of stability loss, because of disuse, leads to further pain and arthritis.
If you've got poor propriception, you're going to not cope with unexpected twists, turns, stumbles, loss of balance. So you're more likely to fall, which is gonna cause more injury. So by getting on top of their physical capabilities, we can actually influence disease progression.
And this is really demonstrated here. This is Bonnie Milton. This is an average home with your lovely varnished floors with your marble kitchen floors.
This dog has severe lumbosacral disease. And that is what the dog would do 20 to 30 times a day. The lady worked from home.
The dog had separation anxiety, likely influenced by chronic pain. And 20 to 30 times a day, the dog would do that. Think of the forces that are being put through a painful, unstable region of the body causing spinal cord pinching, spinal nerve pinching.
Next one. Another dog, a bilateral stifle disease, more than likely and cre creches. Let's just watch that again.
Struggle, struggle, struggle. I only just lay down. That dog had fallen down those stairs twice.
So we need to be looking at the environment that we're asking these debilitated dogs to live in because it really does influence pain and progression. So now that we've realised that the environment that we have them in can influence their, their locomotion, their comfort, let's add a bit of disability in here. Let's look at this lovely old terrier.
A bit of a wobble, a bit of a loss of balance, having a sniff, bit of a stumble. Whoops, oh yeah, let's have a slippery floor. Let's add some stairs, some steps to the back garden.
So let's look at the environment and what impact that's having on the dog's planes state. This is another dog, as you can see, just trying to step over that threshold. Takes a lot of Adjustment.
So pain on loading will encourage weight shifting to reduce the pain. Lack of loading leads to disuse, muscle mass loss, soft tissue dysfunction. For us to locomote correctly, we need a fine interplay of our nervous system, our soft tissues, skeletal and articular system.
We need to have appropriate locomotion to cope with everyday activities, and if we don't have appropriate locomotion, we need to consider what these everyday activities could potentially do. So one for like, this is Bertie. Bertie is a dear friend of mine's dog.
He absolutely adores this black lab. He lives near the beach and his dad is a kitesurfer, so he's always on the beach, doesn't think anything about it. His dad is a graphic designer and so he gets home late from work, gets the ball chucker out, goes to the beach, logs it up and down the beach a few times.
He also lives in a 3 story house. And has always used the front door, and then he walks around the corner and goes up the steps of the footpath to cross this bridge. The dog had a rightful lameness that just wasn't shifting.
We had the dog on recoil, paracetamol, we're considering gabapentin. By just changing this dog's lifestyle of coming in the back gates and going into the centre, 2nd floor of the house where the dog lived, we avoided those stairs. The right floor lameness subsided, and we didn't have to add more medication.
So game changer at #5, I think we're ahead of the game, time wise, I'm proud. Game changer at number 5, we need to have a new way of thinking, and this is really from the heart. We have a welfare issue, and we've been plugging away saying this for many years, but I'm glad to say at the beginning of this year, we now have a body of evidence to suggest that it is.
So the Royal Vet College has been working with the University of Sydney on a project called Vet Compass, where they tap into, I think it's around about 1000 practises in and around the UK and they get to look at what consults we are seeing. So what is our workload and how long are we seeing for? And what they came up with when they reviewed all of the most common reasons for a consultation.
The most common was dental disease, obesity, and anal sac disorders. The diseases that affected the dog's lives for the longest, dental disease, osteoarthritis, obesity. But the ones that left the dogs so debilitated osteoarthritis, otitis externa, and dermatitis.
So OA features in the most severe for the longest period of time, and I think that is a really massive shout that we need to change our approach to managing this disease. Looking at more details. Reasons for euthanasia.
Musculoskeletal disease features right up there, only second to every kind of neoplasia, every kind. But let's actually look at this list in a little bit more detail. So.
Collapse. I know in my 17 year career, a common reason a dog is rushed in for an emergency euthanasia is collapse, and many of them are because they've got no strength in their back legs anymore and they can no longer walk. Aggression, we've already talked about behavioural change.
These are dogs that suddenly change their personality. They don't cope with social situations, they become intolerant of members of the family, of other dogs within the family. Non-specific signs.
I've certainly learned on my journey through arthritis that a lot of things that I never thought were connected to chronic pain can be. Incontinence, I talked to you about dogs that find squatting to go to the toilet painful, so they actually have urinary retention when they go to sleep, they dribble. Is it true urinary incontinence or is there an aspect of overflow?
Sheexia, so we've got muscle wastage loss here, disuse. And other. So when you consider that, have we actually got musculoskeletal disease featuring at the top of reasons for euthanasia, and this figure absolutely is scary.
24.5% of Labradors are euthanased due to musculoskeletal disease. So that means that tomorrow when you're at work, and there's 4 Labradors in that waiting room, at least one of them is going to go throughundurable pain.
For months if not years, leading to eventually euthanasia, and I think that is shocking. Because the truth is, it's the pain of arthritis causing them to exercise less, their joints seizes, movement is unbearable. They choose not to stand, they cannot stand, and they're put to sleep.
This is not just arthritis, this is a terminal disease, and it involves pain. So there needs to be a dramatic change in the way that we think. So this, this little pore in front of us, I hope you can see that we have got metacarpophalangeal changes.
You can see that there is some swelling across the the knuckles, and that's more than likely digital OA. And it's a very common thing for people to say, oh, it's just a bit of arthritis. Now why don't we completely shift the way that we manage this disease?
And at this point, we turn around and we say, he has arthritis, it's a progressive disease. That can lead to unnecessary suffering and premature death. We need to take this more seriously.
Your dog needs to lose that excess weight. You need to stop throwing the ball. We need to stop this dog jumping in and out of the car and having 6 times its body weight going through these painful joints.
We need to consider medication. We need to explore, explore different avenues. By talking to them differently right from the outset, we will have a more engaged, committed owner.
We must stop using the terminology, it's just arthritis. But should we go further? And should we be introducing joint protection from a young age?
Remember right at the beginning, the beginning of this presentation, this disease is a common problem in the young. And we shouldn't be shy about talking about it in the young, and I'm gonna show you why. It is definitely wanted, featuring here with somebody suggesting puppy clinics.
They've already had to look after an elderly dog if they knew more at an earlier stage. So let's just think about the environment effect on the young dog, and how can we start this conversation easily. This was a study that was done, on 1,733 individuals, and it was pure bred boxer dogs, and they looked at how the dogs were reared and the risk of developing congenital canine hip dysplasia.
And those that had been reared on a slippery material on the box floor had a 1.6 times likelihood of developing hip dysplasia. Something that people so commonly link just to a genetic predisposition.
It's not, it's multifactorial. An environment plays a massive role on whether this dog will have good joint formation. Let's also look at this study.
So this was looking at the activity that these dogs were doing in the earliest parts of their life. So the opportunity to exercise daily in parks up until the age of 3 months reduced the risk of hip dysplasia, so the appropriate movement. Whereas use of steps during the same period of time increased the risk.
So these are young dogs that have gone to a new home, they've got laminate flooring throughout, the kids are running up and down the stairs, the dog's running up and down the stairs. Their joints and bones are still growing. We need to be imparting information about the appropriate means of making sure these dogs form correctly.
Around this point home, this was the video clip that I just found on YouTube. Yes, it's not pretty. See, no attraction.
Oh yeah. This is common. Oh, there goes the hips.
We really need to be having the conversations with the owners about their environmental influence on this dog's growth. So, what is the ultimate holistic approach? I think it's more reckless drugs.
I am very passionate about us being more aware of our environment and its influence not only on the development of the disease, the progression of the disease and the pain. So just to help you along with your newfound passion for environmental influence on chronic pain, we have a tool that's on our website. It's called hashtag ItsmyHome too, and it's a 16, I think 17 question questionnaire trying to help owners make good decisions with house adaptions.
It's a digital version, which is full of lovely pictures, or you can print it off as a PDF and hand it to your owners in your clinics. Joint protection, as I said, is an integral part of pain management in human medicine. I love this.
Ignore the dog's weight. Turn of my diet at the moment. Here we have a ramp in action.
Imagine this dog's body weight going through those front legs if it was asked to jump out of this car. This is just such a beautiful video clip. Enrichment, getting out, seeing the world, different smells, different sensations, so important for these dogs.
The tail starts wagging and the wind in the ears, beautiful video, beautiful. So canine arthritis management, what are we, who are we, why are we doing this? We believe that changing ownert and public perception of how to treat chronic pain in animals will lead to improved lives for animals and their owners.
We are. A website, this has guest blogs, conversations, and downloads that your owners can print off. We're looking to completely rebuild this platform.
I'm gonna talk to you about the big walks in a minute, but I wrote this in 2016 and I've learned so much in the last three years that I just want to be. Given the opportunity to to to develop this. There's so much more we can add.
We've got more media now, we've got more lifestyle stories, we've got more ways to actually communicate with the public because we talk differently to them, and this needs to have much more of a public focus. So if you're inspired by what you've heard tonight, then please do get in touch. We have a big presence on Facebook.
We spend a lot of time on here because it is the way that people communicate nowadays. And we have Holly's Army, which is an owner focused group. We have canine equipment reviews, we have the OAA team, which is for people that have been trained by CAM.
We have the CAMS student hub for people that are either vet students or therapist students, etc. And we also have CAmbassadors where we're trying to train the public to influence others to follow evidence-based medicine approaches. We're on Instagram and Twitter.
And we're developing our YouTube platform. We also have a shop where we sell cam and slip tape. We have 5 different tapes as modelled here by the lovely Holly.
It looks perfect in your waiting room. We have a clothing range, yes, we have a clothing range because we want the conversation to be started. We want owners to be talking to each other about prevention of early euthanasia because of the chronic pain.
Our hashtagodogmore Years features on this snood, we have hats. We're developing that range so we can encourage dog owners to start the conversation. We have a range of booklets, and the OA booklet is designed like a vaccination card so that you can have better communication with your clients and also if they choose to explore a different therapy.
We've got a booklet range of 17 booklets coming out. We've got 7 out currently, and hopefully in the next month, we've got a booklet about complementary therapy, one about how to exercise a dog with arthritis, and one about how do the drugs work. But as I said, there's 17 planned.
We have an online owner modular workshop. It's 4 hours in total, but divided into 8 half-hour modules, and it's there to guide owners through what is arthritis, what interventions, etc. Etc.
And how they can construct a management plan. And it's for the mere sum of 1999 and all funds go back into town. And moving on, your dog more years.
This is one of our very proud, creations, the bandanna. It works on so many levels. It gets the conversation started, it helps with dogs that are debilitated in the park and stops other people's dogs jumping on them.
It's particularly useful if you like going to the pub and getting people to not knock into your dog who is already just, just coping with the situation. And it's a brilliant community builder. So we have many, many Holly's Army followers that go out proudly wearing this bandanna.
We encourage practises to purchase them, to not only sell them, but also to use them in the practise. If you've got a dog in that's maybe having a dental, but it's a known arthritic, by wearing the bandana, anybody that's handling that case can do considered handling to make sure that we're not putting undue stress and forces through these compromised joints. So getting to the end, with plenty of time to spare.
Game changer number 1, we need to catch this early. Game changer number 2, we need to be employing a team approach. This isn't something that we can do on our own.
I've become obsessed about it for about 4 to 5 years now, and I still feel that I have so much to learn. CAM, the team is a multi-disciplinary team. We have hydrotherapists, laser therapists, acupuncturists, .
Chronic pain specialists, rehabs, orthopaedic surgeons all feature on the team because there's no way in the world that you can know everything. Send your owners home a visual structure, otherwise they're just gonna go online and they're just gonna start grabbing at anything offers price. Lifestyle changes must not be forgotten.
I have had many situations now where I've dramatically reduced a dog's pain intervention simply by changing the environment the dog's living in. And we need to develop a new way of thinking. This isn't just arthritis.
This is a welfare issue. This is a terminal disease that can leave a dog in pain for years prior to a premature euthanasia. I think we need to be having the conversation a lot earlier.
So this is my lovely Holly, and she's an inspiration that keeps Cam going. So thank you very much for listening. I'm really grateful to Webinar vet for giving us this opportunity, and I'm ready for questions.
Don't worry, we're still here, just take myself off mute. Fantastic, thank you very much for that, Hannah. There was so much information you managed to cram in that time then.
I was very, very impressed with your time management on that. So. So we'll let Hannah grab a quick glass of water.
As I said at the beginning, please do pop some questions down because I know that a lot of information was on over there and I know Hannah could have spent, you know, 10 hours talking about this, never mind, 55 minutes. So I'm sure there's probably some areas that you'd like Hannah to expand on, delve into a little bit more. So you've got a bit of time now to answer some of those questions, but then as Hannah said, you know, her emails there info at canine arthritis.co.uk.
I know she'd be more than happy to hear from you and talk about how you can support clients and what CA can do to support yourselves in practise as well. So please do get in touch that way. Also, as I said at the beginning.
There will be a short survey at the end of this webinar. And on there, it does say, if ask you if you'd like to find out more information on the work that it can do, how it can support the practise, etc. So once again, if you fill in those details, we will then pass them on to Hannah for her and her team to get in touch with you, in due course.
So let's see. So questions, can the new painkiller Gallaprop be used in cats? I don't believe it's licenced yet.
I certainly haven't heard of anybody using it in cats yet, so sorry, but I will certainly write that down and I will speak. My contact in Lao and just check if there's any movement there. Fantastic.
You jumped ahead of me. It's about to answer a question, you just jumped straight in, Hannah, so yeah, I've jumped straight in, is that OK? Yeah no, that's absolutely fine.
So next question we've got is from Kaine, and Kaine's asking, are throwing devices a contribution to arthritis evidence based? No, there isn't any evidence out there where they've done a trial where they've taken a load of dogs and they've used ball throwers and they've compared it to a number of dogs that haven't had ball throwers. So I did do a lot of looking around to try and find material to substantiate our advice.
But we do know from human work that impact forces, torsional forces, and the more violent they are, has been linked to earlier onset arthritis. So what we need to remember is, looking at the joints as an organ rather than, you know, separate. Ligaments and support structures are part of the synovical cap.
So if you are doing activities that are leading to ligament sprains, for example, you are influenced the synovium and if you create a synovitis, then you are creating an inflammatory situation within that joint, and we know that it is inflammatory change that influences arthritis development. Brilliant. And does that also come back to then you were saying at the beginning, I think, don't know, I can't remember it was the conversation we were having during the webinar itself about the importance of almost warming the dog up before if you're going out for a walk, we're gonna be throwing the ball through.
Don't just go straight into it, but just like sort of get them to gently warm up first before sort of going in full pelts. Is that sort of before. I think it's really relevant.
I think we just need to be thinking. Of our dogs as athletes, they might not be an athlete compared to the agility dog that was in crafts, but they still are athletes, and we know that encouraging the tissues to go through a range of motion and be capable for the job that they're about to perform is a wise move. Going from nothing and cold to 100 miles an hour is not going to be good for soft tissue.
Fantastic. And can we just follow that up with, is there any evidence to suggest early and very early sterilisation increases arthritis as there is increasing evidence of relationship with cruise ship disease? Yeah, I was gonna actually cite that whole cruise ship link.
So there is definitely a link with early neutering and the onset of crushate disease, which is the most common cause of stifle arthritis. There is also links to early sterilisation, obviously having an impact on weight, and even though weight itself, obesity doesn't cause arthritis, it is a consequence. Arthritic progression is a consequence of weight carriage, and we know that weight is a source of inflammatory mediators.
So with regards to actually having studies where they've taken a number of dogs and they have sterilised them at a young age and seen for arthritis onset. I don't know of any papers, but I certainly can look that up. We have a team, but we do know it has a massive impact on weight, which has a massive impact on arthritis.
Fantastic. Hopefully that's answered your question, Cin. We had some lovely feedback.
Jose was saying thank you. It's a truly holistic approach to osteoarthritis and, and that's, Jose's tuned in from Portugal. So, you've gone truly, international now, Hannah.
Catherine has asked, Catherine, yes, I, it's almost this question's plenty, Catherine, Catherine's saying a couple of her colleagues were unable to make it. We have an opportunity to see this webinar again. Yes, this webinar, will be available on our.
A website within the next 4 to 48 hours, that's the webinar vet.com. So please do, if you're talking to your colleagues, in the practise tomorrow and they're interested, direct them to the website.
They can click on the card and register if you haven't got an account with us and be able to watch it free of charge, and it will be there for the next 6 months. So yeah, so please do direct anyone, to that. We will also be sending out reminders to say when it is available on the website, so you can tune in and also watch this again, because as I'm sure if you miss some bits of information, then you can review it or even do it, use it as a lunch and learn in the practise, and then obviously take it from there.
Someone was asking Hannah, any advice for setting up mobility clinics? I think there's loads. Yeah, there's, there is loads of advice about that, .
Basically, am I allowed to say that we did a webinar for somebody else that they could go and look at? There are no other webinar providers available as far as I'm aware. No, that's fine.
If yes, basically, I would really, really look at your practise taking it as seriously as you can. So when I talk about the OA 18, it's about going to work tomorrow and saying to your, your colleagues. Which receptionist is interested, which nurse is interested, which vets, and let's sit down and come up with protocols, plans, aims, ambitions.
How are we going to make this flow? How are we all going to sing from the same song sheet because this is something that we hear about on Holly's Army all the time. Owners don't like going back to the same practise and seeing a different vet every time who says something different, and they actually contradict each other.
So a simple statement of saying, oh, remaia's better than metican. Just because that, that, that's vet's preference can be, you know, it, it's really disturbing for the owner because they feel that they didn't receive a good service in the consult before. So this could be managed really well by the practise having protocols of what's our first line anti-inflammatory, what's our first line supplement, what's our preferred diet, what's our, what's our game plan, what's our structure?
Do they see the nurse before the vet or is the vet before the nurse and Talk and the team what you want to create. There is a set plan because every practise is different. Every practises different layouts, different timescales, different numbers of staff.
We will do more on this. Me and Danny are doing a Facebook Live tomorrow on our platform talking about complementary therapies. I think there's one booked in October with Lindsay about how to set up an OA clinic.
So please do stay pinned for that. Brilliant. And all that information will be on your Facebook pages and all the rest with the app, brilliant.
Danielle has typed 7 in, hi, Hannah. Do you have handouts for owners guiding them about environmental changes within the home? Yes, so there is a booklet.
It's, it's the first one that I wrote. It's very close to my heart because it features Holly a lot. She is the main model.
And it's, it's a picture very easy to read, 40-page booklet which I find gold dust because the printed word is more powerful than the verbal word. If somebody's taking the time to make a booklet with pictures, it must be the truth. So you can get that from the cam online shop.com.
But also go to the website and print it off. It's my home tutorol. It's, it's a PDF, I think it's about 3 pages.
Fantastic. There you are. That's the place to go.
What do you recommend when advising clients about dog beds? OK, so for me, I think that the most the thing that people are upset with is the beds that offer what I want tend to look boring. So anything that's got fluffy, billowy sides, feathers and sequins, I'm, I'm not really that bothered by.
I like the ones that have got predictable edges. They're, they're pretty firm. They've got a non-slip predictable surface.
So that the dog's feet won't get caught up as they're trying to get themselves comfortable. I like them to have at least sides on two edges so that they can lean their back and they can, they can get comfortable and lean against something. But we do remember orthopaedic beds might be too unstable for some dogs.
So we have a lot of owners that go out and buy these amazing beds, and the dog doesn't use it because they're too unstable and the dog feels unsteady using them. So sometimes the firmer the bed, the better. But I don't like ones where they can be trip hazards.
And around the bed, you do not want a dog that's stiff, having just been asleep for 4 or 5 hours, getting up and going straight onto laminate when they're at their most vulnerable. No problem. So it's about the environment that the bed sits on as well as the actual bed itself.
Yeah, cool. Thanks for that. Joanna has said thank you for a great lecture.
Just wondering how useful do you find cartrofe injections in OA patients? I used to use it quite a lot. I'm not using it so much at the moment because I'm doing a lot more stem cell PRP, but .
I must admit I can never predict which ones we're going to do well on it. I found I never had side effects from it, so I would certainly incorporate it into my management plans, and I would know if I was going to have improvement because generally by the 2nd or 3rd of the 4 week course you will have an owner starting to say that they've seen changes. I don't believe that it should be used monthly and the company at Forte agree that it is not a monthly injection.
It's to be given once a week for 4 weeks, up to 3 times a year. As I say, I've never had, I've never had anything negative about it, but I have had some dogs that haven't responded to it. But then it begs the question, have you got the right diagnosis?
Have you got something else going on? Is there something else influencing? And I think as a profession, we need to be getting better at diagnosing this disease and associated comorbidities, so we need to be looking for our tendinopathies, our peripheral neuropathies, and we tend to just focus on joints and something a big tip for you guys to go and look at, if you've got a dog that's got elbow arthritis, fill the muscles over the shoulder blade.
Filled to see whether you've got changes in your supraspinatis. Look for the bicep tendon insertion. Have you got associated secondary tendon changes?
Tendons take a long time to heal. They have a very poor blood supply and it's very painful. So you've got an inflamed tendon.
Rubbing over and down the biceps grooves, that's gonna hurt. So I think something that we need to be better at is looking at sources of pain and then not just being articular. So yeah, get in with your, good clinical examinations.
Brilliant, thank you very much. I hope that was useful for you, Joanna. Just conscious, time sticking on, I'll take a couple more questions.
Once again, a number of people saying great webinar, really interesting, really enjoyed it, so some fantastic feedback for you there, Hannah. Yay, as if we'd be surprised, . Someone's asking if they can print off so yes, you will get a certificate for listening to this if you log into your account on the webinar vet website.
It is more of a CP CBD I'm sorry, was that CPD, certificate, but I'm just, but, Danielle's asking Hannah for the purposes of so they can display it within their clinic to promote awareness. Yeah, yeah, anything like that that you've got on the website you've done with other. Yeah, we started, but we're working on a really cool idea about creating arthritis friendly clinic status.
So we're following in the footsteps of the ISFM's cat friendly. And we're we're we're working quite hard on it and we have a list of criteria before we give you aca approved logo. So that's something you might want to think about, .
But yeah, why don't you just actually get the merchandise. So we have posters, flyers, business cards. So already people know that you've got a more proactive approach.
It's a poster pack, so it's 3 posters, I think it's 50 flyers and 100, little cam cards that take people to the website. And we rely on those sales to keep this going, so please do support us. Fantastic.
There you are, Danielle. That's there for you. Ian has said, once again, great presentation.
He had to start it off, had to nip out, came back in, and he's just saying about, your view on CBD oil, that's why I said CBD, not CPD just before. Now I know you're sort of at the top of, the prep webinar, you sort of mentioned obviously CBO, but we can't get into that, move on. Is that sort of as it stands really.
Yeah, basically, first of all, there's a really good lecture by AMA, AVMA. I'm afraid $5 but it's the American Association and it's an hour long, and it gives you a really good overview about CBD and it's quite impartial. So I'd definitely advise you go there.
We've got two CA conversations about CBL so go onto the website. We're not really supposed to even be talking about it. Personally, I think there's real hope, but at the moment I think we're far from it because the companies that are marketing and selling it, we don't know what they're selling, what quantity, you know, what, what, concentration, and there's a lot of evidence that, the products that are readily available either have huge levels of CBD, some have THC in them, some don't actually have CBD in them at all.
As you say, they're so easily purchased and even though the VMD have clamped down and says it's illegal to be selling them for animal use, it's very hard to regulate that. Your homoeopathic vet, I don't know how they're getting away with selling it, to be quite honest. Because I know we, myself and my colleague were over at WSAVA in Toronto, in July, and they, there was a stand there and they were, talking about CBD oil.
And it seems that it's a little bit more, widely available, in the US. And that's why I presume Ama have been doing a webinar on it because maybe they're a little bit further down the line, but they were saying that, yeah, in the UK they were finding. It was a lot more difficult to get people talking about it and that attraction.
I think it's really worth going onto Holly's Arbie. So if you're going to spend any time on a farm, just, just go onto the Holly's Army group because they're, they're generally not crazies. They're really lovely owners.
And we try and not influence people. Opinions and what they found. And I'm, I'm seeing a real 50/50 where some people are going on it and they, they really feel that they've seen improvements in their dogs sleep patterns, their, their comfort levels, etc.
But there is a big cohort of people that have tried it and said they didn't see any improvement whatsoever. There are two clinical trials out there, one's been published, but the cohort numbers are quite small, but it did show beneficial effect with osteoarthritis pain. So I think it's, I think it's really exciting.
But unfortunately, I think the commercialism is, is, is ruining it, you know, it's so freely available. We don't know safety, we don't know, still so much to learn about it and I know that I used it on my dog many about 2 years ago, and she was already on a number of medications. She had a compromised liver and she started having partial seizures.
Now whether it was the CBD when I stopped all meds, the seizures stopped, and the only thing that changed was adding CBD. I think we need to learn a lot more about it. That's it, and I wouldn't comfortably suggest it now.
No problem, that's great. Thank you very much for covering that. Just two more questions, and then we'll, wrap it up for this evening.
The first is from Jeff. Jeff said, I was asking, what about racing greyhounds? Would this intense activity be expected to contribute to an early onset?
That's a lovely question because, yeah, potentially. So if we've got dogs that are having injuries, so articular related injuries, so that could be anything to do with the joint capsule, the supporting structures. Yeah, absolutely.
So even if you had soft tissue injury and you are having postural change and adaptive movement, you're going to have adapted joint movements. So you're going to be putting forces through areas of the articular cartilage that may have had the forces disseminated, but you're now Having them more focal because of an adaptive posture to make an action happen. So, absolutely.
I can't substantiate that. I haven't got any papers to hand to go, that's definitely the truth. Be who would, that is Richard Payne from the University of Nottingham.
He does amazing work looking at trackside injuries and whether these dogs go back into, full race capacity. He'd be a brilliant one. I'm gonna ask him actually.
There you go. I'm gonna give him an email. There we go.
So Jeff, watch this space and will you post a response on the yeah I can do. They can come on to Facebook and I can put it there, that sounds good to me. So that that'll help Jeff.
And last question here, what's your opinion about giving omega 3, mechanism, possibly by reduction of or inflammation? OK, so just to make the point, I am, I'm not a specialist, I'm somebody that listens around the world to what everybody's saying, and this is definitely an area that the specialists agree on. So omega 3 fatis from cold water marine-based sources has been shown with evidence base to affect the inflammatory cascade.
So you're taking the inflammatory pathway in a positive direction by Swapping in omega 3s into the place of omega 6s, so yes, but they take time to effect, so implementing them, you're not gonna see a rapid reaction, it's gonna be something that's gonna take a good 3 to 4 weeks to have effect. So putting a dog onto an omega 3 that you know is actually painful and hoping that it works, no, you should be putting the dog on the omega 3 in the background, using other means to control pain, which most commonly is pharmaceutical, but there are other things such as TES, laser, acupuncture, etc. And then allow the omega 3 to build up into the system to get into the cell membranes to have that positive inflammatory push.
But yes, there is strong evidence to suggest that's a good direction. Fantastic, thank you very much. Well, I think that's it for all the questions.
Just to let you know, you've got an invitation from Mina. Mina is one of our great, one of our great members, and Mink, you'll be pleased to know Minka lives in San Diego, . Swimwear.
Yeah, exactly, so Minka's saying, you should come to California and start your lectures over here. Great presentation. And tell me when.
And Steph's saying she looks forward to seeing Cam at Blue Bear in September. I hope you know what it means. Yes, I do.
Fantastic. No worries, well thank all leaves me to say thank you very much to all of you for attending this evening. If any, as I said before, if any of your colleagues did miss it or, haven't been able to, attend this evening, then please do let them know that the webinar will be on the website within the next 24, 48 hours.
Just go in, log in, and they'll be able to watch it there as well. Obviously, please do check out Hannah's Facebook pages, social media presence, and also the website there's a load of great resources there and the more that yourselves can start talking about in practises, the better it's gonna be for the welfare of our canine friends out there. And, you know, Hannah and the team.
They do do, I say, day courses for the for practises to help you implement the strategies into the, into your practise more and more, and well worth doing. I know she's, the practises that Hannah has worked out, had fantastic results and fantastic outcomes from it. So, you know, I would really encourage you to consider that and get in touch with Hannah and have a chat about that as well, .
Obviously the survey will be popping up shortly, so please do complete that. So then all it needs to do is say thank you to Phil, who's been on the other side of things, help him look after you all tonight. And then obviously last but not least, thank you to Hannah for such a superb, presentation and spending time answering all your questions.
So thank you very much for that, Hannah.