Episode 12 - Two Week Takedown. Difficult owners, aggressive pets, spinal surgeries in GP and no antibiotics for pyo's?

Episode 12 – Two Week Takedown 🎙️

Difficult clients. Aggressive patients. Big surgical decisions in general practice… and no antibiotics for pyos?! 👀

In this fortnight’s Two Week Takedown, we’re diving into some of the real-life challenges that every vet team faces but doesn’t always talk about openly.

We kick things off with the tricky topic of “difficult” owners — how to manage expectations, communicate effectively under pressure, and keep consultations on track without burning out. Then we get into the realities of handling aggressive or fearful pets, sharing practical tips, honest experiences, and where the line sits between safety and patient care.

From there, things step up a gear…
 Spinal surgery in GP?! We explore the growing conversations around what procedures are (and aren’t) appropriate in first-opinion practice, and the risks, ethics, and pressures behind those decisions.

And finally — a hot topic that’s been stirring debate:
 No antibiotics for pyometra? We break down the thinking, the evidence, and what this could mean for how we approach one of the most common emergency conditions in small animal practice.

As always, it’s honest, unfiltered, and designed to feel like a conversation you’d have in the staff room after a long shift.

🎧 Whether you’re in GP, referral, OOH, or training — this one will definitely get you thinking.

📖 Read more & explore our blog:
 https://www.chattyvets.com/blog

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💬 Got thoughts on these topics? We’d love to hear them — drop us a message or join the conversation online.

Transcript

SPEAKER_01 0:09

Welcome back to the Chatty Vet Pod. I'm Brendan. And I'm Charlotte. Thank you for tuning in. Welcome to our first podcast of April, our next two-week takedown episode.

SPEAKER_03 0:20

This is where we aim to bring you up to date with all the latest news and products in the UK from the last few weeks.

SPEAKER_01 0:25

We hope you had a lovely Easter, even if you were working like Charlotte.

SPEAKER_03 0:29

Yeah, it was a busy one, definitely. But I'm glad it's over. Back to a bit, a little bit of normality again after the bank holiday madness. And massive shout out to anyone else who, like me, had to work over the bank holiday weekend. You're all amazing. And we hope you're definitely getting some well-deserved rest now.

SPEAKER_01 0:46

We've got a busy show today. Do you struggle with getting owners on board with your treatment plans? Well, we're going to try and solve some of these issues for you today. The other things we've noticing are spinal surgeries being done in general practice. Is this good or bad? And who's using antibiotics in Pyometra?

SPEAKER_03 1:04

Yeah, lots to get through today. But first, we wanted to say an absolutely massive thank you to everyone who's subscribed and listens to the podcast, and especially everyone who joins in the discussion on our social pages or sends us messages. This podcast really was built for everyone working within the veterinary profession, and we love it when you get involved.

SPEAKER_01 1:24

Yes, absolutely. And because of this, before we start, we wanted to say a quick thank you to a few members of the chatty back who've been leaving comments recently. We really enjoy reading them. Here's some of the comments we've had.

SPEAKER_03 1:37

So Musical Games said they love the podcast and find it really relatable, which is exactly what we're hoping for. So thank you very much for that.

SPEAKER_01 1:43

And Foreman FGF said they've just discovered the podcast, listened to all the episodes already, and asked whether it counts as CPD. And the answer is yes, you can absolutely count the podcast learning as CPD. So if it's helpful in practice, then we're very happy about that.

SPEAKER_03 1:59

We've also had a couple of really nice clinical contributions, which is super useful because you know we're only GP vets, we're not specialists. So it's really, really nice to get you guys talking about clinical discussions. Tell us when we're wrong, agree with us when we you think we're doing something right. And Lauren mentioned she'd use subcutaneous ketamine for chronic pain in her own staffies and might be able to dig out some old papers for us, which would be fantastic. So, Lauren, if you're listening, please do send them in if you do find them.

SPEAKER_01 2:24

And Michaela suggested V Gels for airway management, saying they're great with capnography and for dentals, which is a great tip.

SPEAKER_03 2:32

Yeah. And lastly, we just wanted to say thank you to Louise. She sent us a lovely message on Facebook to say how much she was enjoying the pods. So thank you very much. It really meant a lot to us. But generally, thank you to the chatty pack in general for all the comments. Please keep them coming. We read everyone and we really do take all your opinions on board. So okay. Now, on to some of the juicy topics we've got planned for today.

SPEAKER_01 2:55

Hey, something that's been in the news a lot the last few weeks, the um final conclusion of the CMA agreement.

SPEAKER_03 3:01

Yeah, yeah, yeah. If I think everyone's been chatting about it again. But to be fair, I don't think it's been as much of a hoo-ha as when it first when the CMA agreement was at first initially launched. I think everyone was like, oh my god, but I've not heard as many people talking about it recently, but maybe everyone's bored of it already, even before the report came out.

SPEAKER_01 3:19

Yeah, I think that was their plan, wasn't it? I think I I definitely feel clients are are really telling me that they don't want that they're really hostile to private equity. I think there's been a massive increase awareness about practice ownership or corporate ownership and and and a huge negativity around that. Whether that's I suspect that's not completely fair. But um and then the other little part of that is one of the things was um you have to disclose whether you belong to a a corporate ownership. Is that that's one of the big things, isn't it?

SPEAKER_03 3:51

Yeah, yeah. I think it's making sure that uh it's obvious that you're part of a corporate, making your price lists um a mandatory requirement to have them on your website so that everyone can see exactly how expensive you are. I think they're gonna have a set thing uh where you need to say exactly what your prices are for particular procedures because they want to do that price comparison website or something, don't they? Where you can go online, go compare or whatever it's gonna be, and you can basically compare vets in terms of prices. So that's gonna be a big change, which will be strange. Um I don't know, I feel like it's gonna I don't know whether this is gonna make veterinary feel more or less like a business. Like if clients are gonna be able to have a look online, you know, like how you'd shop for your car insurance. Is it gonna feel the same as choosing a vet? Like, does it take the personality out of it? It's a bit of a shame, isn't it?

SPEAKER_01 4:38

Well, you could you and we know that uh a dental isn't one thing, is it? You know, there's uh every practice has got different levels, you know, where some will radiograph every single single thing. You know, there's so many variations. Ultrasound's another great example. One person's ultrasound is not the same as another's. So there's so many things around pricing that are just very hard to to be fully transparent. But I suppose it's it's a start, maybe.

SPEAKER_03 5:03

Yeah, yeah, it is. And you know, things like absolutely needing a written estimate uh for over 500 quid, but they have put the exception for true emergencies, which I think makes a lot of sense. Because sometimes, you know, if you've got a GDD that walks through the door, you don't really want to be like, hang on, let me just write you out an estimate so you can sign it for me. I need a yes or no, do you want me to treat? So um, yeah, I think there will be some good things out of it, but I think there's still a lot more that needs to be explained, isn't there? Um it'd be interesting to see the effect that it has over time to see what happens from it, you know, where it all gets taken. But I don't know, I guess only time will tell.

SPEAKER_01 5:36

But there we are, hopefully drawing a line, draw a line under it and just focus on good relationships with clients because that's what it's all about, them trusting us and us trying to look after them.

SPEAKER_03 5:45

We've had loads of comments asking us how we deal with clients when they're either difficult or not willing to take your own fighters on board, which can be really tricky. So we thought we'd spend some time in this episode talking about these difficult consults and conversations we have and how to deal with clients when it's just not the easiest consultation.

SPEAKER_01 6:03

Well, we all know con we all know conversations can be difficult in the consult room sometimes, especially if clients are disputing charges, arguing about money, or insisting on particular treatments such as antibiotics. Jack on Facebook dropped us a message and said he found dealing with these clients insisting on particular treatments really difficult as a new grad and wanted our opinion on these cases.

SPEAKER_03 6:24

Yeah, I mean, we've all had uh it's always ears generally. So it's ears or chronic diarrhea cases because you've had that one person that has come in time after time after time with say, I don't know, they're spaniel who goes swimming all the time and it keeps getting these recurrent ear infections, and they come back and every time they're just like, I want another bottle of cornoral, or they call up and they just want another bottle. And you're like, has anybody had the allergy discussion with you? Are you on meds to stop these from happening? Is it a resistant infection that's just not solved? Like throwing the same medication at them every single time is not gonna be the thing that fixes something. You know, if it's not worked before, it's not gonna work again. But sometimes trying to get those clients on board can be really tricky, can't it? It's really hard. I don't know. I think I always try and say, look, I'm gonna come at this from a different angle for you. And you know, give me a second to explain where I'm coming from. And I know you've had all of these opinions before, and I'm not gonna tell you that they're wrong, but I'm gonna give you my opinion and then we'll have a little discussion and see what you think. If you can honestly come across as really genuine and saying, these are the reasons why I think this is better, even if they turn around and say, No, I'm not gonna do that, then at least you can write in your clinical notes. I have given them all of these options and they still say no. So it's, I don't know. Have you got any different tactics? I think for me that's the thing that works best.

SPEAKER_01 7:44

I really liked what you said. Oh, it's good. Um, I think the first thing I do, because they've often sometimes they might have their back up because they've been, you know, they perceive, oh, I'm just coming in to get my canoral eardrops or cerillan eardrops, whatever. Um, and now I have to pay a consult fee and da-da-da-da-da. So um to get to kind of to stop their back being up too much, I might just say something along the lines of, look, absolutely fine. I can get you the the medicated eardrops, that's no problem. But did you know that the reason underlying this problem could be allergy? And I noticed you came in twice last year for eardrops. Is there is I don't know if there's if anyone's talked to you about what we could be doing to prevent them from happening, something like that, which I think is similar to you, whereas you're you're trying to disarm them straight at the beginning by saying, Yep, no problem, here's your eardrops fine.

SPEAKER_03 8:28

Yeah, I've thought it so many times with you know, metronidazole used to be given all the time for chronic diarrhea cases. It'd come in, you'd give it probiotics, you'd put it on gastrofood, and if it didn't get any better, you'd put it on metronidazole for five days. And I've had lots of clients come back and say, Oh, I've done that like five times and it clears it up every time. And I'm like, but it keeps coming back. There's a reason why it keeps coming back. We're not fixing the problem. We're just throwing antibiotics at something that's not actually getting to the root cause of what's going on. And I think it is just coming from that point of view. It's saying, you know, yeah, I can understand that that's worked. And to be honest, it probably would work, but this is what I'm gonna suggest that I think will be better for you. And you can say, you know, take my opinion with a pinch of salt if you want to. It's an opinion. It is my medical opinion, my professional opinion. But if you would rather do something else, that's fine. But bear it in mind because next time you come back when it doesn't work again, we can go back to my option if you prefer it that way. So it's I think it's just planting that seed. And nine times out of ten, they'll follow what you want to do. But even the clients that are like, no, absolutely not. I want to do what I've always done, you've planted that seed. So the next time they come back, they then might go, Yeah, actually, you know that thing you discussed with me like three months ago, maybe we can try that now. And you're like, yes, won them over finally.

SPEAKER_01 9:42

I think the other thing you I do is I look, it's not always possible if you're super busy, but if I can, I'll go back over all of their history. Um and so you know, I'm a bit obsessive about using AI sometimes to go over it because they will have a lot of those ear cases will have had every treatment under the sun. They'll have had a little bit of this and that all the way along. And the owners at this point, especially if the dog's eight or nine years old, they you know, they've lost faith. I think we have to understand that the client might have lost trust and lost faith in what we're saying, or they felt like they've heard everything already. So if you know their history really well, you can go, oh, by the way, I see a vet gave you um those tablets uh, you know, a couple of years ago. How did that go? Oh, and then my is it's amazing how often they'll go, Oh well, it went really well, but uh we we didn't know if to carry them on, you know, things like that. So I think knowing the history wins trust. That's a great way of winning trust. You can do this like more or less. I mean, sometimes as well. I'll look at the history of that animal and the especially because I'm working a lot of new practices at the moment and the history from the previous practice. We talked about trust in one of the previous episodes, didn't we, about vaccination? Trust also comes from knowing the history inside out, and then straight away someone's like, Oh, this vet's taking the time.

SPEAKER_03 10:56

Yeah, it is a little bit of a luxury in terms of time, because I think we're quite lucky to work in practices where we have consultations that are fairly long, which is great. And obviously, if you've got 10-minute consults, there's a limit as to how much you can look up. But even looking up, say, like with those ear consults, if you can say to an owner, I can see in the last three years you've tried five different products, they'll go, Oh my god, really? Because they don't remember, they just use what they get given. They don't remember exactly what they've used. They go, Oh, the one in the orange box seemed to work quite well, but they don't remember what they're called or what they do or how many they've gone through. So if you can say you've used five different products and you're still coming back with this problem, like something's not working. So even if you're not going into it as in-depth as what you've said, Brendan, if you don't have the time, if you can pick out something like that almost as a bit of a shock factor, again, it might just get them on side to think, actually, yeah, maybe I do want to open my mind to something new because maybe what I've been doing isn't working.

SPEAKER_01 11:52

But it's if you approach it from the point of view that they've never heard it before, or you you don't know all the things that have happened before, they're gonna start glazing over because they're gonna go, oh, this guy doesn't know. I did that, I did that tablet like three years ago and it didn't work in my dog. But if you can go, well, you did that tablet, but there might have been a secondary infection at that time because I can see this wasn't done, or you didn't carry it on, or there's a higher dose, or there's a newer version. Well, you did that tablet last time, but did you know there's a newer version of that? And then straight away the conversation's gonna go so much better. The other one I think a lot of vets struggle with is older cats. I feel like the o the the owner of the older cat is in a different mental frame of mind to all other owners. And funnily enough, they're all the same, I find, almost, pretty much. So nearly everyone with an older cat, and by older I mean 14, 15 plus, I suppose. Um, they don't want to, you know, they don't want to stress their cat out. Doesn't matter if it's living with three million diseases, they don't want to stress their cat out. Um they're not interested always in doing anything like surgical, they don't need to know what type of cancer it has, they don't want to have anything invasive. So straight away, to get them on board, you need to kind of calm them down because they're gonna come in going, it's a 14-year-old cat, bloody vet's gonna want to do a million tests on it. And what's the point? What's the point? You know, they literally the best owner and the worst will come in like that. Yeah, so you know what I'm getting at.

SPEAKER_03 13:16

True. Yeah, yeah, yeah. I when you said invasive, that's exactly the word I use because I say I've been there, I've had geriatric dogs, cats myself. I understand they get older, they do develop conditions, like that's fine, but there are lots of things that we can do to make them more comfortable without having to put them through a lot. And I sort of say it's not something you have to do. Again, I phrase it as a it's an option, but I say if you really want my advice, there are quite a few metabolic conditions that if we know that they're going on, we can treat with medication. Diabetes, we've got new Cemvelgo and stuff now. People don't have to even have to give injections. You can change diets, you can hypothyroidism, you've got medication you can use to treat. So I reel off some of these things and say, yes, it means that they have something that's going on, but potentially we can treat it, make their quality of life better, and it's not that much stress to them or that much stress to you. And I even say, if we do bloods and don't find anything wrong, one, that's a good thing, but two, it gives us a baseline. Because if in six months' time you come in and you say, I don't know, Coco's really unwell, she started drinking and weing more, then I can say, okay, well, six months ago we did bloods and her kidney values were completely normal and now they're not, which tells me that she's either had some sort of AKI or she's had a CKD that's now started to develop. Do you see what I mean? So it's I think it's phrasing it from that point of, I'm not forcing you to do something right now, and if you don't do this, you're a bad owner. It's not like that. It's a, these are all your options, and if you don't want to choose them, that's fine. But this is what I'd recommend, and these are the reasons why I'd recommend it.

SPEAKER_01 14:46

Yeah, I say something like, look, I don't want to find out necessarily exactly what's wrong with your cat, but there's one or two little things that I can treat really easily, just with a little bit of medicine in the food that I find they take really well. So I don't want to test for everything, but if I could just test for those things that I can fix quite easily, you know, and the other little phrase I've put is um, look, in these older cats, it's really important not to do too much, but also we don't want to do too little too, and we need to find just the right balance.

SPEAKER_03 15:15

Yeah, exactly. It is all just about having that discussion. And even when we get back onto the topic of cost discussions with clients, I mean, we all know how much it's been in the media recently, and especially with everything going on in Iran, with the oil prices and everyone spending loads of money because of how much more expensive everything's getting, it's only likely to be getting worse for us, really, in the near future. I know that Alice and Theresa on Facebook, along with a few other people, both express their concerns about how to sort of have the cost conversation with clients, especially when people are under the impression that we earn loads of money and we don't understand. And it's it's how we deal with clients that are being really difficult about money when we're trying to suggest the best things for their pets. So, I mean, I know you said that you you have a discussion like we both do in the concert about what we think is best for their pet in terms of just treatment options or medicines, etc. But how do you do you adapt your technique when you're talking about cost? How do you have that kind of conversation with an owner if they're saying, well, I can't afford this or I've only got 100 quid or I try and reassure them firstly.

SPEAKER_01 16:20

I'm like, look, don't worry, look, we can let's there'll be a way we can do something. Um and then um I say, let's just try and work out what we can do. And I try and give them options. I've got quite a few backups where, so for example, let's say the patient needs IV fluids, I'll be like, okay, look, you can't afford hospital. Or we we and I might phrase it in in ways that they'll find more palatable. So I might say, because I can get the feeling that they can't afford the IV fluids, I might go, well, and also they would have to go to the 24-hour centre overnight, and it is very stressful, isn't it? And it turns the whole thing into a big thing and they're less likely to eat in a big hospital. So how about we just do some subcut fluids and just see where we are tomorrow? And and then I obviously you put your little caveats in, but I try and put them in quite gently. So, you know, and obviously if things are getting worse, not better, through the night, well, you might have to go to the outer pounds, but at least this way we might try and avoid it. So I think as if you can be creative with solutions, uh I don't know, yeah, does that fit with you?

SPEAKER_03 17:15

Yeah, I think so. I think it definitely depends on the situation for me, because I definitely empathize with our clients with cost 100%, especially if you're in a practice where you don't do direct claims. Like I I've been in a few places where they will not do direct claims for insurance and they're asking people for all this money up front. And I get it, times are hard, everything is expensive, I understand, but I think it definitely depends on the type of consult. If I'm doing a skin console, for example, and I'm talking about an itchy dog, if people can't afford Apaquel or Cytopoint or Zenrelia or whatever, then yeah, fine, they've got steroids as an option, and I'll go I'll talk them through all of that and I'll say, you know, yes, there's more side effects, but equally we're fixing the problem because they're less itchy. So that is equal and a medication that's going to do the trick, it's just not the perfect medication. But I think the discussions I find really difficult are the ones where you feel like there is not really another option. It's like your your big things like your C-sections or your GDVs. Blockcat. Yeah, it's those ones that I think are more tricky for me because you know, normal consultation, pet isn't dying in front of you. You've got loads of options, and you can say to them, you know, it's not ideal, but if you don't have a lot of money, we can work with that. And these are all your other options. So, yes, if you did have more money or if you were insured, then yes, these would be your options. And I think they need to know that, but it's equally fine to treat the problem using this. That's fine. Have that discussion. But I find it really difficult when I mean I work overnight, so I get it all the time where I get like a bitch that's in dystopia and it's you know those puppies aren't going to come out, you know it needs a C-section, and they've got like 200 quid. Obviously, the insurance isn't gonna cover a C-section because it's to do with breeding unless they're with that, is it NFU Mutual or something that do like farm or whatever? It's it sometimes they cover breeding, I think. But I find those really tricky because it's you end up getting to the point where you're like, these puppies don't come out, you're probably sacrificing the puppies. At least the mum will die if they don't come out eventually, and it's how you get around that problem. Block cats, for example. If a block cat came in and they had no money, then I'd say, okay, well, I methadone them. I do a systol, it's not ideal, the bladder might rupture and you need to know that. But if I if I methadone them, loathe them with medication to go home with, not NSAIDs, because obviously you don't know what their kidney values are doing, cysto them to get them out of the emergency situation and pray that it reduces the back pressure and they start urinating. If people have no money, then fine, you've got them out of the emergency situation, bought them 12 hours and you see where you're at in the morning. But again, you have that conversation to say this is likely to be a recurrent problem anyway. And if you have zero money to be able to deal with that, is it something that you want to embark on in the first place? I th I think it's you have to have those sort of frank discussions with the owner as well as keeping the animal's best interest in mind. It's really hard, isn't it? There's no right or wrong, and I think everyone does it really differently, don't they?

SPEAKER_01 20:11

This is like eMERGE versus GP now, because you now you've gone into your eMERGE job and I've gone into my GP job, even though in the past we've we've been so like you're talking like an eMERGE VET there, because you you've just passed me that bloody cat in the morning's gonna come in with a massive bladder. I'm gonna have a list as long as your arm all ready to see. And now this client's going, Well, the emerge vet last night has drained his bladder until it might unblock magically. You know, so now I'm gonna have to be the grown-up and kind of talk them through euthanasia or whatever we're gonna have to do. Well, no, I mean I always watch the shift, haven't you?

SPEAKER_03 20:44

No, no, no. I always have that conversation with the many mate, and uh euthanasia is always an option that I give those clients. Always. If it's an emergency and they have no money, I will always, always, always offer euthanasia and I will always say this is the ideal treatment, but you don't have the money for this. And you know, if you don't have the money for this, then this is your second option if you don't want to go for euthanasia.

SPEAKER_01 21:08

Well I bet you don't say it like that. I know you. You wouldn't have to do that. This is the ideal treatment, but you don't have the money.

SPEAKER_03 21:15

Yeah, but I do I I do honestly say sometimes, I'm like, look, to hospitalise your cat overnight, to to an aesthetiser or sedate it, place a place a urinary catheter, get it on fluids, do some bloods, you're looking 1500 quid to get you through to the morning. Like, and if if you're telling me that you've got 100, 200 pounds, realistically, that's not gonna completely fix your cat. It's gonna get them through to the morning in the most ideal way, but it's not gonna fix them, and we need to think about where we're heading. I think these conversations are never easy, and everyone is gonna have a completely different opinion. You know, it's like C-sexons and bitches. I give them euthanasia as an option, which a lot of people are gonna go, oh my god, that's horrendous. But I'm like, but it's then no longer a welfare concern for the bitch because she's then not independent. dystokia anymore. And it yes, it's awful. But also, you know, what do we do? They pet owners have to pay for something. They can't get treatment for free. And if they've gone into, you know, if they've gone into breeding their bitch and they've not gone for the morning after injection, if they don't want puppies and they've just let it go ahead, then sometimes these things happen. Do you know what I mean? It's that there is accountability somewhere. And I'm not saying that's just the owner's fault, but it's not all fairies and sprinkles all the time. It's it's like it's not nice sometimes. And we have to have those horrible discussions. I don't know. Ultimately in those situations I just give the owners all the options. But it it also depends where you work, right? Because your practice might do payment plans, they might they might offer full direct claims, they might like I know Vets now do consent to pays and stuff where you can pay like a minimum amount and then you consent to pay the remainder over the next month. So it's there's loads of different options and if I would say talk to your practice managers or your bosses and say, you know, what are the options in these situations? Because the more options you can give those clients, right, the better for the client and the better for the animal, right? But sometimes you are stuck between a rock and a half place. And if someone comes in with two quid and they need a GDV surgery, then it's not going to happen, is it? Which is the sad truth of life sometimes. And it's, you know, I have spoken to a lot of people about euthanasia in pets that probably could have got better if they'd have had the money to fix them. But they don't and sometimes that it's just something that happens. But I never say to them you don't have the money so you've just got to put it to sleep. I don't say it like that. I'm like you know say if it was a GDV. I'd be like you had an extra 50 quid you know I I mean I'd I'd phrase it like they might not make it through the surgery anyway. They might die under the GA there's no guarantee that I'm going to get in there and there's not going to be gastric necrosis or I'm not going to do need to do a splenectomy at the same time. Even if I pexy it every now and again sometimes they do it again or they at least get gastric dilatation again. Like it's not a simple black and white your dog will get better or it won't. Like you might spend all this money and it still might go wrong. So it is not wrong for you to make the euthanasia decision but those are your two options and ultimately if you cannot afford the second one we're left with euthanasia. And it it's having the conversation it's all about tone. It's about tone and the words that you use it's not about saying you're wrong because you've not got the money to pay for this. It's about saying these are your options but ultimately we need to be realistic and this is where we're at you know I don't know maybe I'm better than it's sure I think we all we all do the same thing.

SPEAKER_01 24:37

I know what you what you I'm sure what you do is exactly the same as me because once you kind of I like I sometimes say look it's not an ideal world. In ideal world we'd all have all the money in the world and all the time and everything will get done but it's not and we have to be realistic. And um but then obviously just like you I'll focus on I won't then focus on that I'll move on and kind of go but you know sometimes you you do all of these things and then you regret it because there's complications or they recur and you look back at the whole thing and you wish you'd never done it. So it is okay not to to put this put the cat to sleep you know so you're focusing on something else is but there's some truth to it as well isn't there it's not complete it's not a complete lie either.

SPEAKER_03 25:14

No 100% and it's even like with your block cats you think like oh God it would be so easy to just date it and unblock it and it'd be fine. But you think how many have you seen where they're either a nightmare to unblock or they come back to the hospital like four times in the same year with the same problem and then end up getting put to seat by the owner later down the line because they can't deal with it anymore. And I'm like well there's actually nothing wrong with yes the first time they block you don't know it's going to happen again but there's a high chance like and it is okay to have that conversation of saying this could be a really really long road like even if you can scrape the money together this time you know I say to people I don't want you to get in debt and to be struggling to pay a bill for months and months and months you know put more money on your mortgage just to try and pay this time for it to possibly happen again in three months' time and then you'll wish that you didn't do it.

SPEAKER_01 26:06

And I I will have that it it that frankly and say I'm trying to look out for you you know it's yeah I mean I was going to say when you say that don't you just see their shoulders drop and they just breathe out and they have a little bit of a relief because when you've said just what you just said there, they suddenly go, Yeah okay okay this is okay to do this. I feel okay now it gives them permission but summing summing that up it's I think it's making sure that they're reassured that you're going to give them you're going to get things sorted for today. Whatever, I don't know. You're reassuring them that you're you're you're there you're going to look after them you're going to kind of try and get the best outcome for them because I think they that does help them start to relax a little bit. Give them different cost options and different timelines and then you just kind of put your little uh caveats within that so that you're kind of covering you know all bases if they and um and I actually managers everywhere will hate me saying this but I actually go yes these things are really expensive it does cost a lot of money it is really hard I think a lot of people struggle with costs because I want to legitimise how they're feeling for them.

SPEAKER_03 27:11

Yeah.

SPEAKER_01 27:12

Not feeling like well everyone can afford 3000 pounds straight away for for this problem.

SPEAKER_03 27:18

I normally use the phrase as well of saying this is not the wrong decision. It's never the wrong decision. It might not be the perfect decision but it's not the wrong one and that's what you need to know because I think people think that anything but the best is not right and it that's not the case. It's just not the mo the most perfect or the most ideal but that doesn't mean it's wrong.

SPEAKER_01 27:38

It's but then and this is where we talked a bit about contextualized care that idea that it's not just all the medical stuff but it it's looking at the whole picture.

SPEAKER_03 27:46

Taking that sort of contextualised care discussion onto what we're going to talk about next. I mean we've we've had a little chat about money issues and maybe clients not being on board with your treatment plan or what you'd like to do. But compliance can also be how to administer medications, how frequently are we giving them or also is the dog or the cat really difficult to handle? Have you got a feral cat that you're suggesting you give twice daily injections to have you got a dog that absolutely will not take tablets having those sort of conversations with owners is also really important. So for example if you've got a really elderly lady who's got really arthritic hands asking her to like quarter a tablet is going to be really really difficult.

SPEAKER_01 28:29

Yeah no I totally agree this it segues right into this in terms of when you're talking about the options you need to this is this comes with experience as well you need to know what's around the corner and what what the owner might be thinking that they're going to struggle on. For example with diabetes they might be in their head thinking I can't get the flea spot on on on that cat I'm not going to be able to treat for diabetes in my head I'm thinking I'm not going to be doing any tests on him because he's he's the worst cat in the world. So I think that's the other part of of getting an owner on board with things is understanding their situation and the things that they might have in their head that you wouldn't all automatically know that they're worrying about.

SPEAKER_03 29:05

Yeah I mean the I had a big one that I found really tricky recently and it was it ended up being a really sad situation to be honest. So I had a Rottweiler that I was seeing in practice and and he wasn't really old. I think he was maybe maybe four, three or four. And it was owned by a young couple but he was really aggressive at the best really aggressive I couldn't get anywhere near him. So they muzzled him and they were great with him and really good at handling and they just said you know we'd we do everything outside walked up jabbed him and walked away that was our sort of vaccine console I'd have a chat to them while he was in the car talk to them about how he was doing blah blah blah and then I'd walk up jab him and walk off because he was you know he was that aggressive type of rock while that would have bitten my hand off if he wasn't wearing a muzzle. Well he came in for a vaccination about probably a couple of months ago now and before they got him out of the car so I went in with the vaccine already in my hand ready because I'd seen him before and they were like he's not quite right. He's been intermittently vomiting for the last week. He's just a bit more lethargic than normal he's weeing a lot we're a bit worried he's got a urinary tract infection and I was thinking oh I really hope it's a urinary tract infection you know and you think I really hope it's not something else. So anyway again I could there was no way I was going to be able to do a clinical exam on him. So I sort of said okay well let's get a urine sample first we'll rule out a UTI and then we go from there. And my brain was going like oh my god if he's got like Addison's and he's getting poorly how am I going to deal with this dog? How am I going to hospitalize him? Blah blah blah. Anyway, I did think about diabetes was praying it wasn't. Anyway, tested its urine absolutely full of glucose full of ketones and I was thinking oh my god this dog's diabetic and I just thought how on earth am I going to manage this? It's at the point where it the guy wasn't scared of him but I could tell the woman was getting a little bit nervous. She was fine when he was happy and normal at home but I knew that if I asked her to administer some treatment to this dog she would have got a bit nervous and she was early stages pregnant as well so I was also had that in mind. Anyway, I chatted to them and I was like look I'm really sorry I think he's diabetic and I had the very big conversation of if he is diabetic, which I'm very certain he probably is but if he is diabetic, that means once or potentially twice daily insulin injections for the rest of his life. And that needs to be something that you know from the get-go because if you know diabetes used to be a fatal disease before we knew what we used to treat it. Basically long story short they ended up wanting to to know for certain so I ended up sedating it, do a f doing a fructosamine, you know, getting full acid-based bloods and all that sort of stuff to check it wasn't in DKA and etc. Anyway it wasn't in DKA luckily but it had some ketones but it wasn't properly acidotic. So I ended up loading it with fluids, sending off the fructosamine, blah blah blah. Anyway it got to the point where I I was teaching him how to do the injections while the dog was sleepy because I wanted him to get comfortable with it. So we were just injecting subcut saline just for him to practice while the dog was sleepy and I was like 100% muzzle your dog when you do this. I said make it something positive but do not do this without a muzzle on because I was like the last thing I want to do is teach you how to do this and then you get bitten at home. Anyway he turned around after he'd started the drug the dog on meds and it had bitten him and then he brought the dog in they decided to go for euthanasia in the end which I do not think was the wrong decision and they brought it in the dog got the muzzle off as we were trying to sedate it and bit the vet that was trying to inject it really badly. Yeah it was awful. So it's just a horrible situation from the get-go. But again one of those things where I tried to have that really frank conversation with them and be like this could go horribly wrong. You need to think about the fact that you're already a little bit nervous of him. This is gonna make him worse because you're jabbing him twice a day. You have a new baby on the way like what are we doing? You know and sometimes but again I felt awful because I was like I should have pushed them for euthanasia sooner. So many people have got hurt in this process and the dog's been really stressed when actually I had given them that option and I had stressed that option but they didn't want it from the get-go. And sometimes those situations are just impossible. But again as long as you have that discussion and you come across you get on their level and you give them all the options and you say this is not the wrong decision if you do decide you don't want to go down this road that is okay. And I will now say from my experience this has happened before and it has gone terribly wrong. Hopefully other people feel free to use my example say it can go really horribly wrong but sometimes there's never a right answer but there's there's also never a wrong one.

SPEAKER_01 33:32

I don't think you are going to win that one because in the end you've got a dog that's three to four years old as you say. You know let's say they're four years old that's not old. So the the straightaway the owner's not going to be ready to euthanize. They've not really seen if the dog's reasonably still eating four years old I think you're not going to find whatever you say very few owners are going to euthanise at that point I think I think that you have to go through some pain. The only thing in this situation is it was it was the worst outcome but if it had just been like a bit more minor it'd have been better.

SPEAKER_03 34:05

But I think um to to turn a client like that into a euthanasia on the spot is going to you know it's hard yeah but anyway so okay so I think we've we've had a good chat about how to have those horrible client discussions and compliance issues both with animals and our clients etc but I think maybe we move on to some of the more current issues and topics in UK vetmed that we wanted to cover on this episode. So we wanted to have a quick chat about crafts actually because it's just happened quite recently confirmational issues and actually these weird found them really creepy those horrible eyeworms that we're currently now seeing in the UK but before we get on to those we just wanted to touch on the reform of the Veter Surgeons act that's going on at the moment.

SPEAKER_01 34:47

Do you know um they've they're finally making the owners of veteriness who aren't vets um accountable and come under the regulation of the RCDS but you know since about 1985 we've known that the the industry was going to get corporatized and that this was going to happen and all through the 90s it was very much in my education we knew and it's 2026 and we're now seeing they're going to be accountable finally so that's I think that's a really important point. And that I didn't realise actually this but the the term vet the title vet nurse is not like a legally protected yeah so bad.

SPEAKER_03 35:28

How is that not protected still is crazy. Even if just for that we could push it through that would be really really nice. But I reckon they've sort of had this in the woodwork for a while and have been like yeah we probably should do that and then the CMA happened and then they're like shit we probably should do something we probably should make a bit of a stand as a profession now and prove that we're actually making a change. So I think the CMA out of everything that's been happening if it pushes for this sort of reform then it's probably a good thing. Because part of the thing they were talking about is trying to improve standard for things like complaints and transparency and pricing and all that sort of stuff. So I think there's some parts of it that could be really good, isn't there? So we just need to see what happens. Hopefully they will push something through and get some new legislation since it came out in what was the Act 1966 it came out quite a long time ago maybe it should be changed a little bit the flip the fact that we've now got AI whereas back then people weren't using computers like that that in itself tells you where we're at so I think it probably should be changing.

SPEAKER_01 36:34

I don't all I know is it's creepy and that's all I know. Do I need to know more?

SPEAKER_03 36:39

For anybody that doesn't really know about it it's called I'm not going to be able to say this right Thalasia calipida is that how you say it's basically like a white eye worm. It's disgusting that like sits on the surface of the eye and so generally it causes excessive lacrymation in these patients can cause conjunctivitis, eye rubbing discharge yeah yeah and if it's we think it's probably mostly in dogs I don't think there's ever there's a case any cases in cats that we know about but generally if you see them you see them like wiggling across the cornea and the conjunctive is disgusting. I just can't eyes are not my thing anyway but eye worms no thank you I just can't anyway so basically they say if you see them you're supposed to up to date or anesthetise them and flush them out and then they say that I think it's milbamycin that you can use to try and treat them as well that's supposed to help um or you can use moxidectin and midocloper in midacloprid. So I think you can use something like advocate to try and treat them as well but to be honest if you're unsure then look it up at the time that you get one to see which to use but I'm pretty sure milbomycin would be the one that you would be using. And I think milbamycin you can use as a preventative as well. So if they're going abroad to anywhere where you think that they could potentially have eyeworms I think you can use it to try and prevent them getting it but yeah horrible.

SPEAKER_01 37:58

Do you know I that's actually something that you said that's really good because and therefore NextGuard Spectra will prevent it. And every now and then because I think especially in the southeast loads of people are driving with their pet to France and Spain where where it's endemic. Next guard spectra might be an option here because even if there aren't any ticks at least then you you're covering the Thalassia eyeworm. Tell a client about that they'll be getting that treatment in anyway. The Crufts winner someone showed put their phone in front of me and it had a picture of the Crufts winner and of it's a clumba spaniel I believe isn't it and it's got these eyes that just the eyelids are just turning over and hanging off this sort of space.

SPEAKER_03 38:38

Yeah yeah to be fair I didn't really follow Crufts this year because I was working on the days that it was going and I sort of was too tired to have any bandwidth to look at it. But you showed me a picture of this earlier and it just I mean it happens every year that Crufts comes on doesn't it always raises that discussion of like is it right that we should still be breeding these dogs? You know, is it unfair? Is it welfare friendly to be saying that they're still allowed should we be banning breeds? It just brings up that whole discussion again doesn't it I can't remember which country it is but I think cave's a banned somewhere but you found this tool thing that you think might be really useful in terms of trying to combat that didn't you?

SPEAKER_01 39:13

I did this this innate assessment tool and it looks brilliant. It's 10 simple questions for breeders to do and they kind of get a parcel fail in a 70% or whatever depending on their answers and it's really doable and it takes things away from is this a bad breed to is there physical characteristics of this dog that aren't healthy.

SPEAKER_03 39:37

So what what's it checking for like what are you what is it actually looking for it's looking at how healthy the dog is in terms of its confirmation is that what it's doing?

SPEAKER_01 39:44

It's lovely. Yeah so um how far its body is off the ground how curvy its legs are how long its muzzle is in relation to its skull you know is its jaw in like lower jaw in the kind of end at the right place you think there's things a bit about eyelids and eyes as well and eye confirmation. So um very all very sensible things and it's the kind of thing that if we can promote it to clients, you wonder then can clients then go, has your dog had their innate assessment tool? What did they score? You know it gives at least it's going to be a push factor because there's no any any breeder can do it. You just have to tick it takes five minutes on the um online website for this. So yeah I think it's a I think it's a really positive step forward that we should I I I definitely feel like I want to get behind.

SPEAKER_03 40:33

The thing is is we're so far in now with those difficult breeds like your really flat faced Frenchies or your pugs or your Dashans that are just so ridiculously long that you're like, we know you're going to blow a disc you know German shepherds with their hips and we have just bred to so many extremes where there's definitely too many dogs in the UK now that have all these problems already that I don't think banning a breed is the way to go. It's is promoting responsible breedership isn't it that's what it's doing and it's saying this is what all breeders should be doing and if they're not really you should probably shouldn't be buying from them. And if we can get into that sort of mindset, you know like when people buy a Labrador, a lot of the time they're going, oh has it been hip scored? Because it's become more of a normal thing. So if we can make something like this toolkit become a more normal thing that the public know about not just people within the vet profession then we can say okay you want to buy a Frenchie that's fine but what's the score on that thing? Because if it's like 40% then we can say probably not going to be a very healthy dog and it's probably going to cost you quite a lot of money because it's going to need BOAS surgery. And if you ever want to breed it again it's probably going to need a C section blah blah blah. If we can say all of these things then it's going to put people off breeding those type of dogs because we know and which is great because it means that we're going to have less of the ones that do really struggle.

SPEAKER_01 41:52

Um yeah and also if a breeder's got three potential breeding bitches and they use the innate assessment tool and two of them score 60% and one of them cost scores 40% maybe they're going to use the 60% and then in the next litter there might be a 70% then and they'll go, oh, let's breed from that. It's got to be it's gonna have to be client and vet promoted.

SPEAKER_03 42:12

Because I think we've got into this negative mindset about breeding in general in veterinary haven't we every practice will do it where everyone's like bloody breeders coming in again. You know and it's everyone has this really negative perception about the whole thing but I think it can be done really well. It's just about education isn't it that's the main thing it's not that it's the wrong thing to do it's it's saying how can we do it more right?

SPEAKER_01 42:33

I'm really pleased to hear you saying this because I've been the last few years I think it's partly because I did so much charity work and I had a lot of within the PDSA there was there's a lot of breeding going on and there's a lot of breeding going on with breeds that have got a lot of health problems. So I think because of that experience when I see a healthy dog with a great temperament with responsible owners I feel okay to kind of go have you thought about breeding now look it's gonna piss people off because there's going to be and rightly so in some ways because they'll say well there's so many dogs that need a home. It's true. We also have got the crummiest population of dogs because within every breed we're only breeding a sliver of the population and however good you try to do that there's not enough outbreeding there's not enough variety when it's we're always going to run into a new genetic problem because yeah we're not breeding outwards enough. And if if there was anything you could if they can develop this in innate assessment tool and eventually if it becomes good add on coefficient of breeding is is that the term where they kind of look at how genetically diverse is this male and female because I think that's the other thing. We're doing this so badly we we need to do breeding better.

SPEAKER_03 43:48

Yeah and you know don't get me wrong like you say if you're not bothered about having a a really specific breed you know if you're not going to work them and you need them for a particular a reason. I don't know say if you've got a sheep you're afraid You're gonna need a sheepdog, like fine. If you're wanting to go shooting and you need a dog to go retrieve for you, you're not gonna buy like a pug. Obviously, if if you're if you're getting a dog for a certain purpose, that's different. But if you just want a pet, please go to the rescue centres. There's so many lovely ones out there that need homes 100%. But equally, I think we need to change our standpoint on saying that it's not that breeding is bad, it can just be being done a lot better. So moving on from some of the current topics in the news at the moment, I wanted to bring up a discussion that I've been wanting to have for a while. It seems like, and I I quite like the push for it, but it seems like there's more of a push for general practices to do more of their own intensive work up in practice. So to get their own CT scanners, for example, there's a big push for a lot of GP practices to have their own now and be doing a lot of their own work up themselves. And sometimes they're offering that in a package with orthopedic surgery. So say they've got a cert holder who's doing TPLOs or lateral sutures or whatever. But I've actually seen now there's a few places that have CT scanners that are now doing their own vinyl surgeries in-house. I mean, have you have you seen much of this in practice? Because I know near where you work there's a CT scanner in one of the practices, isn't there? What do you think about it?

SPEAKER_01 45:14

I think a five-vet practice, GP practice, could make a CT scanner pay nowadays, depending on your client base a little. Because there's a lot of applications for it when you're trying to do things and do things reasonably well. So um obviously for Mets checks, um, all those joint disease cases, all the the cruciates, the million cruciates, obviously now we're talking spinal, but there's so many. Um, but also medical things as well, which you can net CT and get so much more detail, whether that's pushing or or whatever. So I think a CT is moving into what a big enough general practice can have. I've not not heard of this spinal surgery within it. I I think most mostly because it's the round the clock nursing care, I guess, which will be problematic.

SPEAKER_03 46:02

Yeah, yeah. I think it's it it's just interesting to talk about because uh there was a I mean, I won't go into it very much because it's not super interesting to chat long and hard about a paper, but there was an an article in JSAP recently that was talking about surgeons versus neurologists managing IVDE and dashans. Um, and they were talking about the difference between CT and MRI. Because obviously before CT scans were becoming more commonplace in practice, we'd refer everything and get them to have an MRI, right? But there are now actually a lot of cases that I'm hearing about that are being dealt with in general practice by a cert holder, for example, who is more than qualified to perform those ops, has done lots of them before, has done the certificate. Yes, they're not a specialist, but they could do them, but they're basing it off a CT. And that's I just find that really interesting because we've we're now seem to be transitioning from referring everything, having an MRI and then getting a neurologist to operate, versus seeming to do some of these more in practice with cert holders who are probably surgeon cert holders who are CTing them rather than MRI, which is saving the client money. Does it give you much different information? I don't know. You can see the disc, you can't see the spinal cord as much. Um, but you're still ending up with the same result in terms of surgery.

SPEAKER_01 47:16

But the really interesting thing that this Charlotte, hold on, you can see you can see an awful lot on a really high-level CT scanner.

SPEAKER_03 47:24

Yeah, but I mean MRI is still is that horrible gold standard term, isn't it? Because for your soft tissue it is so much better than your CT. But and I think it it is just that debate, isn't it? Is that is there one that's better? Should we still be MRIing these, or is it okay to CT because they seem to be doing a lot more CTs on these cases? Um, this paper actually said it's really interesting to look at the difference between the two because you think if if you refer something to a neurologist, a neurologist is doing these surgeries every single day, day in, day out. You know, you think how many spinal cases they see a year, whereas a surgeon will deal with a hell of a lot of different surgery cases. So one isn't doing them as often. They said that the majority of neurologists performed concurrent fenestration. So, you know, when you fenestrate the other discs that are nearby to prevent them from blowing at the same time, whereas surgeons don't do that quite as often. But generally they said that surgical recommendations didn't differ from CT versus MRI. So ultimately, is it the better thing to do? You know, are we not having to send them for referral, which is one less ag and less travel for the patient? Are we dealing with it in-house so we're keeping it in a place where they're trusted? The the owners already know the vets that are involved and they they know they don't have to travel is cheaper because CT is going to be cheaper. Plus, you're not paying referral or specialist prices. Is it something we should be considering? But then, like you say, it's having that conversation of, well, if you've not got 24-hour care, should you be doing a spinal? No, probably not, because they're gonna have catheters in, they're gonna have all of this other stuff going on that they need round the clock care. You know, a TPLO maybe is a bit different because if you do it early in the morning and they're able to walk and they're up on their feet, you can send them home that night. Like that's maybe a bit different. So in-house orthopedic stuff, but then equally, again, you have that conversation of okay, you get this CT scanner, where's the line in terms of what you don't CT and what you refer? So if, for example, you've got something that's got a really weird disease going on, like a weird disease, and you think, okay, well, for example, I don't think she'll mind me saying, there's uh a girl that I know near me who's an RV and she's fantastic, and her family have just rescued this dog, and it had a hole in here in its neck, and every time it breathed, it sounded like it sounded like a kazoo. So there was obviously a a hole through to its windpipe, and it it got CT'd in the practice, fine, so they they got some images, but it asked that question of should we maybe have just referred it to the place where it was going to actually be fixed? Because that surgery was never gonna get done in GP practice, like any GP vet would have gone, no, thank you.

SPEAKER_01 49:53

Like that's an airway surgery. But I think you're right about the MRI versus CT. We need to ask if in fact, if can we open it out to any any neurologists out there that want to comment on MRI versus CT and is there occasionally because it might it might be one of these things that nine times out of ten it's fine, but one time out of ten it isn't. And for us, we can have the chat with the client and well, you know, the now and then it is better to have the MR. You might be better to go to the big hospital. Yeah. But I don't think I have that information. Yeah.

SPEAKER_03 50:22

Yeah. Cause like, for example, where I work at the moment, we're doing CTs and we're doing spinal surgeries, and uh the patients do really, really well. We have 24-hour care, like they're treated really, really well in a really great hospital environment. And I think it's a really good standard of care for our patients. Like it's fabulous. It's something that I'd recommend. But it would be really interesting to get a neurologist's point of view to say, okay, is there things we're missing on a CT? Why should we well, in what cases could we be potentially promoting an MRI versus a CT? Like, for example, if you've got a breed that's not normally a spinal breed, like I don't know, if you have a Labrador that starts to look spinal, are they the ones that you're thinking actually, maybe that's not a CT candidate because it's not a Daxi that's likely to have IVDD? Do you know what I mean? If it's if it's a common breed with a likely a common issue, maybe they're the ones that we're CTing. Whereas our ones that could be a bit different, should they be the ones we're MRIing because we're looking for something a bit weird and wonderful? Maybe. I don't know. It's just yeah, if anyone has any opinions or comments, then please do let us know because it's it's nice to see the sort of the pros and cons and the people for and against it. So yeah, do let us know.

SPEAKER_01 51:26

Yeah, you make a really good point there. And I had a Labrador with a Marcel tumour in its spine, and that yeah, that was a great example. Um, the other thing is if it's got more complicating factors, I don't know, it's let's say it's it's got no deep pain for three days. Is there times where you're gonna want more information about the spinal cord, which you may get from an MR, which you wouldn't get from a CT?

SPEAKER_03 51:45

Yeah, for sure. So finally, just before leaving you for the week, we wanted to touch on a really common disease process that we see all the time in general practice and how they present and and also how we manage them, because I think it's something that we see so often that maybe because it's so common, we don't really actually talk about how we each individually manage these. Pyometras and bitches, you know, we all are doing them quite often. We all know how, well, once you've been qualified for a while, you know how to do a bitch spay. But I just find it really interesting to talk about how people might be used doing these differently still, you know. Is anybody still medically managing these patients? And if we are, which patients are we doing that in? What what are we using? Are people oversowing stumps or are people not oversowing stumps? Are people using antibiotics after they've done the surgery or are they not? And I just think it's really interesting because we don't really chat about them that much because it's something that we're all so used to doing.

SPEAKER_01 52:42

So here's a question, Charlotte. Pyometras, do you send them home with antibiotics?

SPEAKER_03 52:47

To be honest, people are probably gonna shout at me, but yeah, I do.

SPEAKER_01 52:50

Because but I think it's because you being a surf person.

SPEAKER_03 52:55

Yeah, I think I do because and I know that's probably wrong in theory if I'm being really, really, really good with antibiotics, but I just think you never get the entire uterus, right? You always have the stump left behind, and there's always going to be some pus in that stump. And I just always think, I just have this horrible fear that the one that I don't give them to will be the one that gets septic, that gets a peritonitis, and is, and I know probably it would only be very local and it might resolve itself and blah, blah, blah. But I just think you've put them through this massive surgery in terms of antimicrobial stewardship. Are they the ones that I want to be risking not giving antibiotics? Probably not. Like I know some people nowadays don't give antibiotics for dog bites if they flush them out. But I'm like, this dog bite is dirty. It's yeah, you can flush it, but I've seen so many that haven't had antibiotics that have come back with absolutely gigantic abscesses. And I just think, but surely they're not the ones that we should be risking. Yeah, if you've got a suspected UTI, get urine sample before you give it antibiotics. Like, absolutely on the same page, but it's literally got pus inside it. I don't know. I just feel like, oh, it's not the ones that I want to be risking, but I might be really wrong on my own.

SPEAKER_01 54:06

You're bad now because there was a big study that kind of basically let us off the hook and said you don't need to do antibiotics post-operative. You do it intra-operative and then you don't do it post op.

SPEAKER_03 54:16

I'd just be really interested to hear if there are people that are regularly doing these and don't give them antibiotics, let us know, please, because I'd actually be really interested to see how many GP vets on and aren't having any issues. Because if there are a lot of you out there who are doing it, I will probably change my practice. Because if I don't need to be, I don't want to be giving them antibiotics, but I'm just a bit nervous that if I stop, then they're gonna get these horrible infections. And it's one of those things that's hard to argue with an owner with, isn't it? If they say, well, they didn't send me home with any antibiotics, but it had pus in its uterus, so why have I not got antibiotics? Do you see what I mean? I think it's that hard thing. If it comes back to bite you in the arse, it's difficult, isn't it?

SPEAKER_01 54:56

I'm only giving you a hard time because I probably was sending home with a few days of antibiotics, but like just like what I think we said about something else, where you look around at all the other vets, and once everyone starts doing it, you kind of go, okay, I'll do it now. But you kind of need to let someone else start it or some or you know, enough people start it before you feel confident. But um I do think there's good evidence that we don't need it. So, but um I I'm still um a bit of a wuss too. But I think obviously if you've done it perfectly cleanly and if you feel that you have got all of it out at your cervical ligature, and you know, then you know I suppose you're you're okay not to give the antibiotics and you feel justified.

SPEAKER_03 55:34

But then it's that question of over sewing. Like when you've put your ligature around your uterine body, right, and you've cut it all out and you're like, great, it's not bleeding, fine, but you've got that horrible flappy bit, you know, the bit of your uterus, it's only a tiny bit, but the bit that's there on the sort of the dog side of your ligature, and you can literally see pus and fibrin and all this crap in there, that I'm like, that that's what I'm using the antibiotics for, because that's there. Do you see what I mean? You're still like you're never gonna get the whole lot. And that bit there, even if it's open, that bit's not gonna drain because your ligature's the other side of it. So, how are we treating that? Which is why I still oversow my stumps, because I'm like, I don't want that to get into the abdomen. But then is that right or wrong? This is the this is what I mean. Like, I think we just do things because we were told how to do it. But actually, I'm just questioning why. What should we be doing?

SPEAKER_01 56:23

We shouldn't be having anything grotty in there, and you can't just hide it away by sewing it over. That doesn't sound right. You can't see it anymore. That's dumb, dealt with that. But I I must say, I've never appreciated pus in the tiny gap beyond it. But I suppose if there was some, you should flush it, shouldn't you? And well, but then do you?

SPEAKER_03 56:41

Like, is that what people are doing? That's the question that I'm asking. Absolutely. Yeah, exactly. That's what I mean. And is it wrong to flush because then you're getting E. coli and all that crap in the abdomen when it wasn't? Like, is it better to oversow and then you use antibiotics? I don't know. Like, what should we be doing? That's the question I'm asking. And we're I'm probably sounding really stupid now. Someone's going, well, don't do that. This is the right thing to do. Like, when I do my pyo, so normally for a bitch bay, I'd do a stick tile transfixing ligature around each uterine artery, and then I do one Miller's knot around the whole thing. But sometimes for my pyos, because they're so big, I do two millers knots. So then even between the two ligatures, you might have like, I don't know, an inch or something, maybe not even that, a centimetre of uterine body that is not going to drain because it's in between two ligatures. Like, how are you getting rid of the crap that's in that? Do you see what I mean? Or does it just is that okay? Because if anyone has the answers, I'd be really interested to know because it's just worth opening up the discussion. So yeah, I mean, I as bad as it might sound, I oversow them because I'm worried about whatever's grotty and they're touching the abdomen, and I give them antibiotics for five days, but that's probably really bad. So, but yeah, if anybody has something that they would prefer to do instead, then please let me know.

SPEAKER_01 57:55

Yeah, I do something similar.

unknown 57:57

Yeah.

SPEAKER_01 57:57

By the way, there was a study that you told me about. I don't know how you came across it. It sounds ludicrous. Yeah. But go on, you do it. Piometra.

SPEAKER_03 58:05

So this is so obviously we all know how to diagnose our Pyometras, right? Like if they're PEPD, if they've got pus coming out the vagina. Sometimes if they're not, but they're closed and they have this big distended abdomen, blah, blah, blah. We we all know what we're looking for, right? But I never appreciated how many Piometra cases get anterior uveitis. I never noticed this, ever.

SPEAKER_01 58:25

So there's this paper in, I think it was January this year, and it was in JSAP, and it said, Can I just say four percent A million vets would be eye-rolling at this because they'll be like, they don't get blood because you know, we've all seen pyos. Who is there is not one vet out there that's gone, oh it's got it's got an anti it's gone anterior uveitis, is there? So there'll be millions of vets going nonsense. So go on, carry on.

SPEAKER_03 58:47

Yeah, apparently this study, but is it just so we're not looking for it? That's what I'm saying. So apparently 34% supposedly of dogs with pyometra develop anterior uveitis, which I find crazy. So, and they're saying that it can be from direct invasion into the eyes with the bacteria that's causing the pyo. And even though you're supposed to stop antibiotics then, yeah, but even if detection of the basically, even if the body is detecting that there's bacteria elsewhere in the body, it's also saying that it can potentially trigger an immune-mediated response in the eye that can lead to anterior uveitis, which I find really weird. And they're saying, again, with antimicrobial stewardship, etc., they're saying that you should be culturing these, in which case you'd need to sample the aqueous human. I'm like, who on earth is gonna do that? Sorry, your dog's got pyo, but I'm just gonna stick a needle into its eyeball. No, plus that's sick and I'm not doing that. Well, there we go. Who knew we could learn so many things from pyos, hey?

SPEAKER_01 59:48

Yeah. Yeah. And uh, if there's any internal medics that are going, no, it's not quite as simple as that, then message it exactly. Tell us all about it.

SPEAKER_03 59:56

Or any of them that are going, Oh my god, I can't believe they're still using antibiotics. What are they working 15 years ago? Yeah, please tell us if we're wrong. Just we would we want to invite a discussion about it, that's the whole point. So we are wrong.

SPEAKER_01 1:00:08

I think you do interoperative antibiotics and you don't do post-op, and that's what you do. And do you know what? I had a um, but it's just that we're not brave enough. We just need if we start hearing everyone going, yep, I do that and it's fine, then we'll feel more confident, won't we? Like, you know, we talked about Brucella in the last episode and all the guidance about that. I had a post-op pyo, maybe I brought it up in the Brucella episode. They some they cultured the pus from the pio, and it was Brucella. Positive. At least that was what was told to me. I was doing the post-op care. But um, is that a good reason? There you go. But that was a bit of a shocker.

SPEAKER_03 1:00:43

Yeah, definitely don't flush the pus that's left in the stump then.

SPEAKER_01 1:00:46

Oh yeah.

SPEAKER_03 1:00:47

Because you're just gonna like aerosolize it.

SPEAKER_01 1:00:49

Oh, yeah, don't do that.

SPEAKER_03 1:00:51

God.

SPEAKER_01 1:00:52

That's a bit scary. So uh but Charlotte, I bet you you've looked at those protect guidelines or whatever on BSAVA, and I'm I'm guessing it's just something really hostile.

SPEAKER_03 1:01:01

Yeah, I know. Yeah, so I mean, I think the difficulty is that yes, the Protect Me Guidelines, so if we were all going to go exactly by the rule book and exactly what they're recommending, they're saying antibacterial is not required if stable and proceeding directly to OHE. And they're definitely saying that in theory, in these patients, even if you're giving them perioperative, they do not need it post-surgery. Little bit in my defense, I guess. I think out of ours, I see a lot of these sick patients, ones that have been going on for a long time. Like they're not the bouncy dogs that have walked in and the owners just noticed they've not been right for 24 hours. You catch it early, you whip it out, they're fine. It's like these ones that for me feel like they're verging septic. And I just think, oh God, that's so scary, not giving them antibiotics. But I do need to be better at it. I need to be better. And, you know, if if there are people out there, because there probably are people that are a lot more brave than I am, if there are people out there that are doing these routinely and not using antibiotics, either perioperative or post-operative, then please, please comment in and let us know. Because I think I I mean, I do need to change my practice. I know I do, and I know we need to not use them as often, but it would make me feel better to know that there are a lot of people out there that are not using them and having really positive results.

SPEAKER_01 1:02:15

It's a good point. If they're reasonably healthy, the uterine wall's nice and healthy looking and not looking damaged, that you know, there's no hint of any peritonitis, and you get the surgery and it's just beautiful and clean. I guess in that model situation, you would, I'm guessing, even I think we would both now feel okay to not do post-op antibiotics, but maybe.

SPEAKER_03 1:02:34

I think yeah, it's it's just that little bit that's left behind that makes me nervous because my surgery's clean. Like I'm not worried about pus being free in the abdomen. It's just what happens with that little stump, that's the thing that makes me nervous. But anyway, okay, so roundup time. We've covered loads today from compliance issues in practice, pymetra management, cost issues, and spinal surgeries in GP.

SPEAKER_01 1:02:57

We hope as ever you've enjoyed listening. And remember to get in touch if you have any comments or suggestions to help us improve these pods for you. Any topics you particularly want to cover.

SPEAKER_03 1:03:08

And just to let you know as well, for those of you who aren't aware, we have a website and lovely Brendan is doing loads of blog posts after these podcasts. So if anybody is really interested in discussing things more, we will be putting stuff up on the blog. So please do keep an eye out as well. It'd be really great to have your have your input on there. So we also wanted to say as well, thank you to the chatty pack who've been sharing the podcast this week. We really appreciate it. So if you're enjoying the show, please follow suit and send it to a colleague and spread the word for us. The more people that listen and enjoy our content, the more of these podcasts we can produce for you.

SPEAKER_01 1:03:43

Absolutely. Please share away. But for now, thank you for listening. Join us again next Sunday for our bonus episode of the month. This one's going to be a little bit different. We're going to take a deep dive into life as a new grad vet, what to expect, what jobs to look for, and generally our take on a survival guide for you in those initial steps in general practice.

SPEAKER_03 1:04:05

Yeah, definitely. So if you're a new grad vet or are coming towards the end of your studies at vet school, or you know someone who is, please spread the word about our next episode that's coming, and we hope to have you tuned in next week.

SPEAKER_01 1:04:15

We're looking forward to it already. Until then, it's Buy From Me.

SPEAKER_03 1:04:18

And Buy From Me. Take care.

SPEAKER_00 1:04:34

The content identified for Jackie Bets podcast is attended for life of technical professionals and for informational purposes only. Drug dosages, protocols, medical advice discussed should be verified against current literature and manufactured guidelines. Always consult relevant laws, regulations, and institutional policies in your practice. Listener discretion is advised.