Age Is Not a Disease (But It May Be Keeping You From Getting the Whole Picture in Your Wellness Exams)

As pets get older, it is accepted that lameness comes with the aging process. You may hear pet owners say “Oh, I know Lucky is getting old” or “He/she is just showing their age”. But should this excuse further investigation into the source of the lameness? In this blog, we’re going to dive into the geriatric wellness exam and explore the tools your practice can use to better serve your aging patients.

Today’s patient is named Dallas. Dallas is an 11-year-old, neutered, chocolate lab. His owner reports that he is doing well for his age and although he doesn’t go for his daily walks (due to stiffness and slow pace), he is still spirited in his day-to-day life. Dallas is in your office for a wellness exam and vaccines.

Cover the Bases

You’ve ordered a complete blood panel and urinalysis to make sure no systemic illness/imbalance is occurring. You briefly examine the patient for outward signs of illness, palpating for any lumps and bumps that may be a cause of concern, examined the mouth and ears and auscultated for any abnormal internal sounds. You have the vaccines lined up and ready for administration. Now you’re done with the exam, right?

What about the stiffness the owner mentioned at the beginning of the exam? Just as you check the bloodwork to make sure systemically your patient is healthy, what about your patient’s orthopedic health?

Pin-Point the Source of Lameness

Where is Dallas painful? Is he offloading from one of his limbs and putting additional strain on the rest of his body, creating numerous areas of stiffness?

To get some of these answers, let’s start by taking a brief Stance Analysis reading. A Stance Analyzer collects several data points utilizing a pressure sensitive platform split into four quadrants. Each of the patient’s feet is placed into a quadrant and the Stance Analyzer provides numerical data concerning the patient’s percent weight bearing by each limb individually, center of gravity and total body weight. A normal reading for a Stance Analysis is 60% of the weight distributed evenly in the front (30% each limb), and 40% in the back (20% each limb).

Dallas is bearing 34% of weight on his left front, 26% of weight on his right front, 21% of weight on his left hind and 19% on his right hind. This reading tells us that Dallas is offloading his weight from his right front and redistributing the weight to the opposite limb, placing additional strain on the left side of his body.

Next let’s take some goniometry measurements to see limitations of mobility in both the shoulder and the elbow. Goniometry measures the percent flexion and extension of the joints and can provide valuable data for where the patient may be limited in movement. In taking Dallas’s measurements, it is noted that his elbow is moderately impaired in flexion and he has some crepitus in the joint on palpation.

Get a Definitive Diagnosis

Now that we know Dallas’s elbow is impaired in function, we can consult with his owner for additional diagnostics to define his lameness. With the numerical and visual data provided by the Stance Analyzer, and the goniometry readings showing limited mobility, we are able to build a case for radiographs to better define the orthopedic injury Dallas is experiencing. After taking a couple of quick radiographs, we can visualize the source of the lameness, arthritic changes to the elbow. Now what?

Create a Treatment Plan that Works for the Pet Owner

Your client originally came in for a wellness exam and vaccines and is now hearing that their beloved 4-legged family member will need treatment for elbow osteoarthritis. Initial shock of the diagnosis and course of treatments may lead to your client to being overwhelmed with financial and logistical challenges. To best navigate this, find out what course of treatment will work best for the pet owner and their financial situation by asking the following questions:

• What is the client’s time limitation?
  • Can they come back to the office for several laser therapy treatments?
  • Is the pet owner limited in mobility to physically move the patient?
• Will the client be compliant with daily/weekly therapies?
• Is the client restricted financially?  
• Does the client have concerns about chronic medications and/or is this patient already on joint supplements or other pharmacologics?

Dallas’s owner works throughout the week during standard business hours, restricting their ability to return multiple times during the week for laser therapy treatments. His owner now understands why his quality of life has decreased due to the stiffness created by the arthritic elbow and would like to pursue additional treatments. The owners do have some concerns about chronic medications, though they agree to start Dallas on chondroprotectants and after discussion, decide to pursue Platelet Rich Plasma treatment which will require a single office visit every 6 months for management of his condition.

Review of the Exam

Through Dallas’s exam, we were able to get the “whole picture” of his well-being. Utilizing the tools of Stance Analysis and goniometry, we were able to collect objective data and educate the pet owner on their dog’s lameness. Utilizing these tools opened the doors to further diagnostics and quality-of-life improving treatments like PRP therapy that otherwise would have been overlooked due to the common acceptance of “old age”.