The Chatty Vets Podcast
Meet The Chatty Vets — Charlotte & Brendan — two UK small-animal vets navigating the wild, wonderful, and occasionally ridiculous world of veterinary practice. Expect monthly news, clinical cases, odd consult moments, and the kind of humour only someone who’s survived a chaotic consult room can appreciate.
We give you REAL confessions from the Clinic Floor: Practical, relatable, and CPD-APPROVED.
We release three episodes a month: two fortnightly updates on what’s happening across UK vet med, plus a bonus episode that might be a clinical deep-dive, a research paper chat, or an excuse to talk to interesting people who also chose this brilliant, baffling profession.
If you work in vet med and want learning, honesty, and a few laughs to get you through the shift, you’ll feel right at home.
The Chatty Vets Podcast
Episode 17 - Two Week Takedown. Neutering Controversies, Euthanasia payments and tricky discussions, plus eye issues FEAT A SPECIAL GUEST!
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Episode 17 – Two Week Takedown: Neutering Controversies, Euthanasia Payments, Tricky Discussions… plus Eye Issues with a Special Guest!
In this episode of The Chatty Vets Podcast, we’re back with another Two Week Takedown — and this one covers some big, tricky and very real topics from life in practice.
We dive into the ongoing controversies around neutering, including the evidence around timing, mammary neoplasia, pyometra prevention, and the rise of ovary-sparing spays. We also discuss the difficult subject of euthanasia payments, client conversations around cost, and how emotionally challenging these moments can be for both veterinary teams and owners.
And if that wasn’t enough, we’re joined by a very special guest — Francisco Gomez, an ophthalmology advanced practitioner, who helps us tackle some common eye presentations, referral considerations, and the practical ophthalmology tips we can all use in first opinion practice.
Expect clinical discussion, honest opinions, a few difficult questions, and the usual Chatty Vets blend of veterinary news, real cases and consult-room chaos.
For veterinary professionals only. This podcast is for discussion and educational purposes and should not replace individual clinical judgement.
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https://www.chattyvets.com/blog
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Welcome back to the Jatty Vets Pod. I'm Brendan. And I'm Charlotte. Thank you for tuning in. And welcome to our third podcast of this month, our next two-week takedown episode.
SPEAKER_06So this is where we aim to bring you up to date with all the latest news and products from the UK from the last few weeks.
SPEAKER_02We've got a busy show ahead, covering lots of topics from controversial neutering debates, and this is quite a big thing, and new evidence linking neutering to various health conditions. And I think we'll be changing how a lot of people give advice around this topic. And we've got another special guest on the show. So keep listening to hear a chat with the lovely Francisco to discuss all things ophthalmology relevant to general practice.
SPEAKER_06Yeah, it's going to be a good one. But one thing we wanted to mention before we get cracking, we have some very exciting news for you. This month we're bringing you an additional bonus episode at the end of the month. So you've got four pods to listen to this month rather than the usual three. Lucky you.
SPEAKER_02Yes, and next week it's going to be a good one. You do not want to miss it. And we've got an amazing special guest on the show, and we're talking about all things regenerative medicine, platelet-rich plasma, stem cells. So it all sounds all a bit otherworldly and distant and remote, but it's here and we're kind of blown away, but it feels like it's something we should all know about now. So more will be revealed on our socials this week. So keep your eyes peeled.
SPEAKER_06I'm actually so excited for next week. We recorded the episode a while ago now, didn't we? And we've been dying to get it out. We absolutely loved it, the interview we had. So we know you're gonna love the episode just as much as we ri enjoyed recording it. We can't wait. But anyway, back to today's pod. Hopefully, still just as interesting for you.
SPEAKER_02Yeah, but before we get stuck into some of the big topics in this episode, let's have a little chat about a few discussions we've been having with listeners recently. So Marcus on WhatsApp had a brilliant message. The first one was about something called Primvet. Have you heard of this, Charlotte?
SPEAKER_06No, never. No.
SPEAKER_02Right. I hadn't either. So he told me about it, and it's it's really good. So it's basically someone, you know how obviously nowadays we're looking things up on AI, but they've created an AI called Primvet that's really targeted at veterinary resources. So it's using uh yeah, a lot of veterinary publications and literature and all of this stuff. So when you do something, it shows you all the evidence, but so you can ask questions, it gives you really kind of referenced answers. It's feeling pretty good.
SPEAKER_06Okay, cool. And you just access it, access it on Google or whatever, you just type it in and you can find it.
SPEAKER_02I've got an app on my phone, I think it says proven vet. So yeah, there's no charge. Yeah, it's you and I noticed on LinkedIn they said they've got 5,000 users in the US and UK. So yeah, I think it's early days. So that that was number one. Yeah. And then so Marcus raised some really good points about opioids and nausea, which I think it's worth knowing because it will affect your clinical practice. So the first thing to say is that opioids cause vomiting through the CTZ, the vomiting center, which sits outside the blood brain barrier and gets hit quickly. But something I don't think I didn't know is that there's also an anti-nausea opioid receptors, which are inside the brain. Yes. So the relevance is now certain drugs like morphine and hydromorphone, they're less lipophilic and they actually hit the CTZ, the chemoreceptor trigger zone, first and cause vomiting quickly. But the more lipophilic opioids, they cross into the brain quicker. So then, yes, they hit the kind of nausea-inducing CTZ vomiting area, but because they go into the brain really quickly, they then hit that anti-nausea effect and they actually don't cause as much vomiting. So these more lipophilic opioids are methadone, fentanyl, buprenorphine. So that explains why there's this little difference between the two.
SPEAKER_06I wonder if there's any difference as well between like if you give it IV versus IM and the speed that it acts, and whether there'd be any difference in nausea because of that too. Like whether because it's going to take do you know what I mean? Like whether that then affects how the time between it hits the CTZ and then crosses the blood-brain barrier, whether that makes any difference too, or whether it's just it happens at the same speed, but it just takes a little bit longer for it to get there. I don't know. So who knows? But yeah, that's really interesting.
SPEAKER_02And the other thing which leads on from it, the clinical really big clinical relevance is the next dose would be less nausea-inducing because now the drug's hitting that anti-nausea in the brain. So you've already got that going on. Which because I think I'm really concentrating when I give my first dose, but I'm not concentrating three, four doses down the line. And you I think you really notice the nausea. But now I think back, yeah, that's true. You don't get as much nausea. And this is something I'm so this I'm so pleased this came on the comments because I've always wondered about it. Uh, Almudina Gonzalez Gilbert lives in southern Spain. And they've noticed that dogs eat grapes straight from the vine in that area, and they're not seeing renal disease all over the place. And I just think it highlights how infrequent the toxicities are when you know someone there, you know, surrounded by grapes literally growing everywhere. Yeah.
SPEAKER_06Yeah. And we've actually had a couple of comments from people like Shauna and Mel on, I think it was on Facebook, wasn't it? As well, sort of in the comments feed to say about how, again, they've had experiences where they've not really had that much incidence of toxicity as well. And don't get us wrong, that's not us to say that we don't need to be worried about it because they definitely are linked to an AKI, but it just proves, doesn't it? Like the evidence is constantly changing. And I think maybe it's it's not quite as scary as we initially all thought it was. But that doesn't mean we should be 100% changing what we're saying to clients. But I think it just means we need to spark more research into it to say, okay, how nervous do we have to be?
SPEAKER_02Now, Shauna, I know you're going to be like, hold on, I didn't say that. So let me just but Shauna said, she said that it's slightly on the other side of the spectrum. Her dog, she had a golden ate half a loaf of Irish soda bread with raisins, and then um they they got the dog to vomit up 22 raisins. They did uh they did diuresis for 48 hours. Now, yeah, like in some ways you kind of go, well, the renal value stayed normal, but what she did notice was four days later there were granular casts in the urine which show kidney injury. You've got that. So then so there was something a bit more nuanced, that one. So there there was evidence.
SPEAKER_06But then I was I would kind of ask as well, if it's been diures for two days and potentially been overperfused for two days, potentially, then how much of the renal injury has come from the fluids and how much has come from the grapes or raisins? That's what I'd ask.
SPEAKER_01Can you get past that's what you can ask, but it's a bit it's not very delicate, is it? To Sean for Shauna's feelings.
SPEAKER_06No, I don't, I don't think she's wrong at all. And I'm saying that she's right, you know, it indicates kidney injury, but I'm just saying it's interesting to think that the injury happened. Yeah, it's a very good thing. Do you do two-day?
SPEAKER_02Yeah, well, go on.
SPEAKER_06Do you see what I mean? Because because most people stick them on two or three times maintenance when they're already normovemic. So we're massively over over perfusing them. We're probably giving renal edema like how much of the injury is from the fluids versus how much is from the raisins. Like we'll never know, you know, from from that set from that case anyway, because you can't go back in time and check. But it's just really interesting.
SPEAKER_02Pet savers, another one control study. Uh dogs that don't have diuresis, look at the urine for urine casts three, four days later. Do the ones on diuresis have evidence of renal harm?
SPEAKER_03Yeah.
SPEAKER_02I think there is some evidence. Yeah, actually, yeah.
SPEAKER_06Yeah, because because would you get casts just from over perfusion?
SPEAKER_02Well, yeah, that's a good point, actually. I don't know. We need a renal specialist.
SPEAKER_06Yeah.
SPEAKER_02That's the next one. If you're a renal specialist, yeah, yeah, come on, message in and we'll have you on. That would be brilliant, wouldn't it, actually? Yeah. Yeah. Yeah.
SPEAKER_06Make us sound like we actually know what we're talking about. And I guess while we're here as well, it actually would be worth bringing up. So I know Kelly messaged in on socials to say, you know, do we actually have any studies RV, you know, because we've been saying for a while now, we generally don't really promote the use of IV fluids after raisin or grape ingestion now. And do we have any actual studies that say why we're doing that? To be completely honest with you, no. And that's the real issue with the topic at the moment, is that there's no evidence to say that it's right or wrong. But I think it's being extrapolated from a lot of human medicine and human research where they're finding things like increased fluid therapy can contribute to an actually worsening outcome in patients with AKI, potentially, like overperfusion. We know that it can cause renal edema in patients. And actually, Brendan, you said something about there's a study where potentially like increased fluids for a few hours even can reduce GFR. So I think there's definitely the evidence there, but specifically for raisin or grape ingestion and IV fluids, the evidence just isn't there at the moment. So that's why we just need to be super careful with the way we're talking to our clients, because we're saying, look, the evidence looks like it's trending in this direction, but ultimately the you know, pet poisons, etc., are still recommending fluids because there's no absolute evidence to say that this is what we should be doing now. But anyway.
SPEAKER_02And we had another one, by the way, which was um Josh Stone, about how we talk about complications from surgeries and complaints, which is a slightly kind of like distressing one for me and you to have to talk about, but it's a goodie, isn't it?
SPEAKER_06Yeah, and I've got some very good stories probably that we could talk about. So I think we probably all do, but yeah, no, I think that'd be a really cool topic. So I think we'll definitely build that into a two-week take time coming up soon. So thank you, Josh. That'd be great. Okay, right, moving on to our big topic for today. So something else we do every day, but that seems to be changing a lot as time moves on. When or if we are recommending neutoring in dogs. So I feel like even what I'm recommending now has even changed a little bit since I qualified. So I mean, I only qualified in 2021. So I think things are really moving, seem to be really changing. But what about you, Brendan? Do you think they are?
SPEAKER_02I'm gonna sound like Sasha know it all now. Because I have a wait. I just I have been telling people what I was taught in the 90s in Bristol University. So credit to the people who taught us, because they were obviously, I don't know, up there. I am honestly genuinely puzzled how I'm just doing what I was taught 30 years ago. So yeah, and but the evidence is definitely building for sure. I think deep down, we've all kind of known this, haven't we, all the time, that specially large breed animals should be delayed neutering, that it's better to let bitches have one or two seasons before we neuter them if we can. And that once they're starting to get to several seasons, then that mammary cancer risk is starting to come. Is this this is a is that a kind of neat summary of where you're at?
SPEAKER_06I think we'll probably Yeah, I think we'll probably get into it a little bit more, but I think the big change is that it's not a one size fits all recommendation anymore. I think traditionally it was always uh neuter them at six months old, everything gets neutered, male or female, get everything out, no pregnancies, no pyos, perfect. But I think it's definitely more of a discussion about breed, discussion about behaviour, discussion about what they want to use that dog for. You know, there's so many other things that come into play now, even IVTD and DAXIS, like there's so many different things that we're talking about now. And I think that we we're now knowing that, especially in our medium to large breed dogs, that if they're neutered early before skeletal maturity, there's definitely a clearer relationship between that and orthopedic disease, so cruciate disease, hip dysplasia, elbow dysplasia. It's a bit less obvious in your small breed dogs, but if we end up neutering early, there can definitely be some sort of issues that are definitely coming out in the literature now. So we know that there's there's definitely a link between cranial cruciate ligament disease. So there's been various studies that have come out that said that neutered male and female dogs have had a significantly increased risk of cranial cruciate ligament disease compared to intact male and female dogs. Um, and apparently those studies also show that the risk of CCL disease in those dogs was greatest with the dogs that had had the least gonadal hormone exposure. So basically the ones that had been neutered earlier rather than later are more at risk of developing that disease. And you know, we see cruciates all the blooming time, don't we? So that's really worth knowing, especially in those larger breed dogs that you know you know it's probably likely going to happen at some point. So that's a massive chat to have with people. But maybe before we dive into some of some more of the issues that we're noticing with early neutering, maybe the big discussion we need to have first is should we really be neutering our male dogs at all? Is everybody still recommending or are there people still blanket recommending castration? I hope not, but maybe there might still be people out there that are. But there's definite links to other issues.
SPEAKER_02I think this is something that we've got wrong for so long. Um, yes, well, from the year 2000, I've been recommending not that it's not a health benefit to castrate male dogs, but that's nevertheless, it's sometimes good to castrate male dogs because of the context. You know, if they're humping everything inside, it's getting in the way of their interactions with other dogs or they're humping guests and it's getting in the way of things like that. Um it's usually the small fluffy things, aren't it? They're like crazy humpers. So there's reasons to castrate a male dog, don't get me wrong, but we need to just we don't we need to be getting away from the idea that this is brilliant for their health. And the way that I've always brought this up is I've I've said, look, when they're when they're not castrated, there are a few things that they can get, usually beyond the age of four or five years of age, prostate infection, the anal adenomas, the perineal hernias, the testicular tumours. But we've also got, and we've got increasing evidence now of all these joint and cancer problems by nutrition them early, and we've got to get and get the balance right and have a more nuanced discussion. Yeah. Is that that kind of fit with you?
SPEAKER_06And I always, yeah, and I always say to people, so I phrase it like for me, it's very 50-50 in terms of health concerns, because yes, if they're entire, there is things that they're more likely to get, or they can only get if they're entire, like testicular cancer, which we know isn't that common, but it can happen. BPH, really common in entire male dogs. But the majority of those sort of things can be fixed with castration at the time if you need to. So if it's a problem, you castrate them. But we now know that there's also a link to diseases by neutering them. So, like the general discussion we're gonna have with cancer, etc., but also specifically to male dogs, prostate cancer, so prostatic neoplasia has actually been linked to be potentially be more likely in dogs that are actually neutered. So BPH is definitely more common in your entire male dogs, but prostatic neoplasia is more common in your neutered dogs. And obviously, that's not something we can very easily fix. So I do have that discussion with owners.
SPEAKER_02And that that evidence has been there for decades, by the way. And I how many times will I have um I'll hear staff saying the opposite? So I think it's something we need to get right. Yeah. Yeah, definitely. It's been well known for a long time.
SPEAKER_06Exactly. And I think we all need to be to have having that behavioural discussion as well. Because, right, we all know that testosterone increases confidence, you're new to them. And if you've got any level of anxiety, nervousness, etc., especially in our dogs post-lockdown, who are all tend to be a little bit that way inclined, you castrate them. And how many dogs have we all seen that have gone nutty and really difficult to handle after they've been castrated? Because then nervousness and anxiety go through the roof. So it's yes, don't get me wrong, and I always say that's very dog dependent. You can never guarantee exactly what's going to happen. For I tend to try and discuss with clients if they're absolutely desperate to neuter, I try tend to try and discuss chemical castration before surgical for that reason. Because if they become a dog that they don't really like, you know, well, maybe that's a bit too strong a word, but if their behaviour becomes tricky to handle and they think, actually, I don't really like this, they've become a different dog, at least it's temporary. You know, you put the six-month implant in and you can go backwards, whereas if you chop their balls off, but you know, no going back from there. So I think, like you say, it just needs to be a more of a discussion. And for the ones that they're desperate to neuter one of their dogs, if they've got a male and a female in the household, I would be suggesting to neuter the bitch rather than the dog. But uh everyone's different. But I think again, it's having those contextualized discussions based on the patient and the client.
SPEAKER_02So Yeah, do you know what? Having given this advice for so long, what I tend to find is people will come back with their boy dog and the dog will be about, I don't know, somewhere between three and five years of age, and they'll go, My dog is wonderful, perfect behaviour, everything's great, but I want to get him muted because other dogs are starting to fight with him or wanting to fight with him, or he's getting more interest from other male dogs in a negative way. So uh but that's that's fine too, because now you've had that extra uh, you know, the skeletal maturity, we've got better body conformation, um, and we've got better health outcomes, hopefully. So, yeah, just be aware of that. I've got a couple of nuances. I don't know if you found this, Charlotte, but I found unmuted females in the same household can be a bit more likely to fight. Normally it's a delay, I find it's kind of two, three years old, two to four years old, that kind of age, where that secondary kind of characteristics are coming through, they're getting more assertive. Yeah, so they're they're the kind but there's so many nuances to this that it's suddenly really hard to kind of guide people through the conversation.
SPEAKER_06Yeah. I think it's basically just to say that it's not a blanket, you must do this. And it's not a blanket, definitely don't do this. It's a discussion, and that's the whole point, isn't it? There's pros and there's cons against it. And for some dogs, it will absolutely be the right decision. For some, it will absolutely not be the right decision. So it's just having that chat and make form your opinion and just chat to your owners about it. But I would say don't have a blanket protocol because it doesn't work.
SPEAKER_02Yeah, let's get into the what the cancer stuff. Because there's there's there's lots of good newer evidence, and the cancer stuff was quite amazing because I think it this was mainly golden retrievers that had increased lymphoma, hermangiosarcoma, Marcel tumours when they were neutered, and roties getting more osteosarcs when they were neutered, and that's kind of scary because I think we all see these types of cases.
SPEAKER_06Yeah, there was an osteosarc stu osteosarc study with roties, which said that I think it was something like osteosarc develops in approximately 25% of dogs that are neutered prior to one year of age, so like a massive percentage. And this was statistically greater than intact counterparts. So there is definitely a link there. And we all know in those big large breed dogs, if they get an osteosarc, even if it's not spread by the time you diagnose it, a big, hefty rotty, not the ideal candidate for an amputation. So if we can try and avoid that at all costs, then great. Same with lymphoma, there's definitely studies out there that say that there's an association with neutostasis with developing lymphoma. And I think you're right, that study was really in Golden Retrievers. So and I think they said something like neutered males in particular developed lymphoma three times more often than intact males. So it's a big difference. So there will there will be more and more data coming, but there is 100% links there. Sex hormones have so much of a bigger part to play in terms of long-term health development, skeletal muscle maturity, etc., than we ever previously realized. So it's definitely more of a conversation to have with owners now. Um, and I think the thinking on mammary tumours has changed a bit from what was traditionally always said. Do you not think?
SPEAKER_02Yeah, uh, yeah, because I always I think it used to always be that evidence from that 1960s study, and that was the that was the only study we had, but it that one, I think once they were having three or four seasons onwards, they were starting to see some mammary tumours later in life.
SPEAKER_06I think it's basically if you neuter before first season, then it gives you a massively reduced risk of mammary neoplasia, especially in your small breeds. That risk increases with every season that happens, but basically if you say after the second season, the the data was something like that it would then no longer reduce the risk of mammary neoplasia. I think the the thing is is that that paper has been shown to be a little bit weak in terms of its evidence. And I think there are now some studies that there's like a systematic review that came out, I think it was in 2025, and it said that they found that there was no real evidence of a protective effect of early spaying against mammary tumours in dogs. How much does it come into play? I don't know.
SPEAKER_02How often do you see um a mammary tumour in a dog that's neutered early? I mean, I've not I've not had it. We can't say that early neutering doesn't have a protective effect on mammary tumours. Because also I've seen a million mammary tumors because it's doing PDSA work, loads of unmuted females. We'd get one every week at a busy when I was in the Oldbury, uh busy PDSA clinic in in the Midlands, we'd one a week, I remember thinking. But when you're in private practice where they're all being neutered, one a year. And it will be a little bit more than a lot of people.
SPEAKER_06Yeah, but but what I'm trying to say is I think there is that link between hormone development, like hormones and mammary neoplasia development. But is there a link between neutering early as a protective effect or just neutering in general? That's what I'm trying to say.
SPEAKER_02So there's not an additional benefit from early neutering. But get what you're saying. So is it now?
SPEAKER_06So I think the initial study that everyone used and quoted was basically saying that the earlier the neutering, the the lower the risk of developing mammary cancer. But I think the evidence for that is fairly weak. So I think we now need I don't maybe if there is one out there, then someone tell us, but I'm not aware of one. It would be ideal to have one that, if they're neutered at the appropriate time in terms of for all the Other risk, you know, once they're skeletally mature, larger breed dogs 18 months to two years plus, smaller breed dogs at least a year, 18 months maybe. If we neuter at that point, is there still a protective effect against mammary cancer? So I think you can still say there is a risk between not neutering them and developing mammary cancer. We know that that is likely, but it's still not 100% certain in terms of when we should be neutering and the risk of mammary cancer. So that's maybe where I think that the field is a little bit more open still.
SPEAKER_02This leads us nicely onto this ovary sparing bitch space. Because have you heard this has just cropped up in my world. Well, one of my friends worked at a clinic in Wales and they were doing this ovary-sparing bitch space. Now I'm not saying this is a great idea, but I can see now I'm starting to understand where the rationale comes from, having, you know, having had this chat about the link between early nutrient and cancers and joint disease. So I think what some people are doing is they're taking out one ovary and the womb. Now, obviously, you've still got some mammary cancer risk, but they're I think they're implying on the upside you've got healthier joints and you've got less cancer risks for other cancers. And maybe I'm inferring this because I'm not being asked to read about all this. Maybe they're saying, well, if you do get a mammary mass, you're on the spot, look out for it, deal with it early, because I find usually it's it's the ones that are left for too long, and they I do think they actively turn more and more cancerous over time. I might be a little bit wrong with that, but that's my experience of it. So so maybe they're thinking, keep an eye on the mammary tumours, and you get all the upside. It's starting to kind of at first when I heard about it, I thought, God, that's complete trash. But at least now I can kind of see where they're coming from.
SPEAKER_06But then I kind of think, well, why bother neutering them in the first place? Because you still have the risk of stump pyOs and stuff.
SPEAKER_02But stump pyos are easy to treat, aren't they? You're just that bit antibiotic and they're done, aren't they?
SPEAKER_06I still think like they're still gonna have the hormonal change. Yeah, they might not be bleeding everywhere, but they're still gonna act differently. You're still gonna have false pregnancies, like all of the other things.
SPEAKER_02They're not gonna bleed everywhere, though, are they? Or they're not.
SPEAKER_06No, no, no. That's what I said. Yeah, so then they're not gonna bleed, but otherwise, they're still gonna go through all the normal hormonal change. You're still gonna get male dogs that are going crazy whenever they're in seasons. Yep. I don't know, I sort of just feel like what's the what's the point? Like either.
SPEAKER_02Well, the point's what we just all the things you just talked about, isn't it?
SPEAKER_06Yeah, but I'm not sure.
SPEAKER_02To play devil's advocate.
SPEAKER_06I just sort of feel like why put something through a massive abdominal surgery for like a halfway house. It doesn't really make sense. I d I don't know. Personally, I feel like that doesn't really make sense. I feel like you take it all or you don't take anything, but I don't know. Maybe I'm wrong.
SPEAKER_02Because you're it seems a bit odd to me. Yeah, I think I do know what I I just think we need more understanding and knowledge about this. Because the cancer risks with neutering, they're patchy, aren't they? We've got the golden retriever thing. Um, but then retrievers are a little bit prone to cancer, so they might not be typical. I think there was something on visas as well, with lymphoma and other cancers too.
SPEAKER_06And rotties get all sorts of weird stuff, don't they? I mean, every I think a lot of the really weird cases I've seen in my career have been rotties.
SPEAKER_02Yeah.
SPEAKER_04So they get all sorts of strange things, yeah.
SPEAKER_02But then maybe we're seeing that signal in those breeds because the signal's kind of louder, so it's easier to spot it in a smaller study. But maybe we're getting just the same thing in others, but it's harder to spot because they're less frequently affected. Yeah. It's it's I think it it kind of opens my mind a little bit. I'm not completely ridiculing the idea now, now that you know we've gone over all of that. You can see where I think it's really important to see where people are coming from. So, you know, and I think I can see where they're coming from now with why you're doing it.
SPEAKER_06Yeah, I can see the principle behind it. I just think I'm not sure I'd I don't know. I don't I don't think I'd be wanting to be recommending a massive abdominal surge, because it is a big abdominal surgery, isn't it? I mean, even lapse phase, it's still a big surgery, and there's a lot of stuff that can go wrong for like a halfway house. It just feels weird to me.
unknownYeah.
SPEAKER_06I think again, it would be really nice to have some studies that say over-respareing technique, is it better than leaving them entire or taking the whole thing? What are the pros and cons, etc.? But we just don't have that data, do we? So, which is crazy because we're something we do in vetmed all the time, and we still don't have loads and loads of evidence in terms of what's the best thing to do. So, yeah. And I think it'd be interesting anyone who's in America to chat in as well, because I think over sparing space are more common in America, I feel like. So, so yeah, anyone who's in America and is doing them really routinely, let us know. Because if you find that there is pros or cons or whatever, then let us know why it's being done quite so much. But yeah, there we go. And I guess it the uh one of the other controversies to talk about at the moment.
SPEAKER_02Can I just say quickly on that over sparing to thing that we have a real problem with female entirely and female neuter, don't we? All of our sex gender things need to have a third category. Anyway, God, yeah.
SPEAKER_06What do you say?
SPEAKER_02Yeah.
SPEAKER_06Like female, female half entire? Like what do you call it?
SPEAKER_02Yeah, self-declared. Yeah, just number of ovaries, that'll be what it'll be, maybe. Yeah. And woo.
SPEAKER_06And I yeah, one of the other controversies to talk about at the moment is the potential link in DAX between neutering and IVDD. So there's been some studies in the last few years that suggest that neutering, especially if performed before about 12 months old, increases the risks of IVDH in DAX. So I mean, I think again, and and there was another one I think in 2024 that actually found that there was no significant difference between early neutered, late neutered, and entire female DAX. So I don't know. I think that again, is the evidence where it needs to be with that for us to be able to say don't do it or do do it or when to do it, maybe not. But I think it there's enough to say there is a potential link there. But then is it just because we see IVDD and Daxies so much that we can for that we can potentially form a link in a smaller study? I I don't know. I think that again, we need to have some more evidence out there to give us a proper push in either direction.
SPEAKER_02There's there's one answer to this question early new to every Dash and until there aren't any more Dashons left because then you won't have any IV D D because you're gonna get some people hating you when they've got taxis, yeah. But yeah. I mean, I own two, well, I didn't. My wife had two bassit hounds, so uh so when I met her, so we had those two, but yeah.
SPEAKER_06Yeah, but it's it's tricky, isn't it?
SPEAKER_02Even more than that.
SPEAKER_06Yeah, but I mean I've seen I've seen it in I I mean, I say probably the same as everybody else, but I've seen it in intact females, intact males, I've seen it in neutered females, I've seen it in neutered males. Watch this space for maybe more evidence that's gonna come out. And again, I wouldn't be making a blanket decision as to whether to neuter or not to neuter or when to neuter based on just the evidence out there at the moment. But I think we need a bit more coming out to let us know definitely. But um, yeah, it's just something to consider. And then I guess on that, you've also got things like increased weight gain when they're neutered. We've all seen that they all get a bit chunky. So I think it's now sort of more normal practice to be saying to people, you know, maybe cut their food down a little bit or try and get them as lean as you can before surgery because you know that they're going to try and put on a bit of weight afterwards. We know that there's potentially a link between increased phobic behavioural disorders and neutering potentially. But the one big thing that we've not spoken about, USMI. So urethral sphincter mechanism incompetence in large breed dogs. So there was that study that came out with the RVC, wasn't there? And neutering in early onset urinary incontinence in UK bitches, isn't there, that they brought out?
SPEAKER_02Um, yeah, 2019 study. So um this is basically uh the big thing is well, I think we kind of know neutering increases the risk of urinary incontinence. I mean, they're saying early onset urinary incontinence, that's significant, I suppose. But also that if you go less than six months, it's another risk factor for getting urinary incontinence. So so it's kind of that timing again. That that yeah, and that was uh particularly relevant to several breeds, wasn't it? Um Irish setters, Dalmatians, Vislers, Doblers, Webbimerners, yeah, Springer Spaniel. Yeah, well no, could I dunno, it's probably other breeds too, isn't it? But they came up.
SPEAKER_06But yeah, that that's quite a big thing. Yeah, definitely. And they brought out some big figures, like there's an increased risk of early onset urinary incontinence in neutered bitches compared with in Thai bitches, and that's twice, twice as likely. Um, and then it's 1.82 times as likely or increased risk of early onset urinary incontinence in bitches neutered before six months of age compared to ones that are neutered between six and twelve months of age. So I think there's definitely a link there. So it's basically saying that if we neuter them early, so six months or earlier, they'd be more likely to develop urinary incontinence in general and to get it earlier in their life than they would do otherwise. And you know, that's a big thing for owners. Like, how many people have you had come in saying that they're ready to eutanize their animal because they're weing all over the house? Like it's a massive thing for people to have to deal with. And they also, another thing to help with our battle against weight in dogs is increasing body weight has an increased risk of early onset urinary incontinence. So if you can say to people, get your dog to lose weight, otherwise it might piss all over your house, might be really helpful. So yeah, it's a good thing to chat about. But yeah, have a little look at the study. I think it was by Grummetau in 2019. There's quite a lot of uh information out there about it, but basically, sort of the long story short is that in your large breeds, just don't lew to them early if you can help it. Try to get them to sort of at least 18 months of age or so, let them skeletally mature. You're gonna reduce the risk of urinary incontinence, these sort of horrible bony issues that we can get, elbow hips, you know, cranial cruciate ligament issues, issues like osteosarcs, lymphoma. I think the evidence is definitely pointing towards nuturing those guys late for sure.
SPEAKER_02Can we say um, because we've we have this little thing on socials with the American, particularly American, maybe North American vets kind of really being shocked that in you in the UK the vast majority of vets inject into the scruff in cats. So, but the other side of that is in America, I think really early neutering is so standard, I believe, where they're neutering at three, four months of age, at least on my vet groups. So correct me if I'm wrong, but I'm hearing very early neutering. And in the UK, that's it's not a common thing. I think there are more non-UK kind of uh graduated vets that maybe are doing even earlier neutering, but historically it was always six months on onwards. Yeah, you see, with I mean, this is the nuance of everything, isn't it? You know, this might have a bigger health issue than uh in especially certainly in the UK population, than um injecting scruff versus leg.
SPEAKER_06Yeah, exactly. And I th I think if you are in America or overseas and listening and you do routinely neuter really early, for example, then please do let us know because I know that we thought people would find it not very interesting listening about vaccinations, but honest to God, it went crazy on social media. So I got battered. But yes, it's it's really interesting, and we love hearing the debates and the different points of view and exactly what people are doing in different countries and why. So please let us know if you completely disagree with everything we've just said, if you think that you really agree and you've got more evidence that you want to share, absolutely please spark a debate with us because we really enjoy it. We love the clinical discussions. What I think we should do, Brendan, is maybe we do a blog post that we release with this podcast so that we can get everybody discussing. So if you don't know about it, we're running a blog. It's you can reach it through our website. The link is on our socials channels, and I'll put a link in the podcast show notes from today as well. So please, if you're interested in getting involved in the discussion, have a little look at that blog blog and drop us a comment because it would be really, really cool to spark a discussion about what everyone's doing in practice now. So yeah, please do get in touch. Leaving nutrition controversies and things behind, um, we've specifically not talked about cats and rabbits in this episode because we knew there would be a whole lot more chat about them. So we'll cover that in a later episode. Um, just before we move on to our chat with Francisco, which hopefully you guys will really enjoy, we wanted to have a little bit of a chat about euthanasias. Now, I know we've touched on it on previous episodes in terms of how to have the discussions with owners, how to do the consult, maybe drugs that we might want to use beforehand. But one of the difficult things that we find is when to have the discussion about payment, because it's bloody horrible, isn't it, talking to people about that.
SPEAKER_02Yeah, this came up because one clinic I worked at was actually quite an affluent um client base, and they started to insist that payment was done at the time of euthanasia, not later. And I think practices really vary on their protocol here. I think it depends on your client base. I don't I personally don't think it's a good look if you're kind of rustling people to the the the counter to pay after you've euthanised them. I think it would probably be better to say a lot of people just want to get it done. So I I'll tend to phrase it, look, some people just want to just get straight out of here. If you like, just get the payment done right now, or you know, but normally I I'd be saying, look, you if it's afterwards and you've missed the opportunity to talk about it, I I personally just unless you've got um really bad client debt or a different different client population, um, most of the time I'd rather just say, Look, don't don't feel just pay when you're ready. It that really is the least important thing right now is you take care of yourself. But am I being too ideal world and woolly, probably?
SPEAKER_06I don't know. I think I always used to do that in general practice. Like it used to be like, you know, I sometimes I'd let them out the back door or the side door so they're not going through the waiter room as well because if they're all crying and it's horrible, isn't it, when you're feeling that crap about something that's just happened and then you've got to stand at the counter in front of everybody and bloody make a payment. It's not ideal, is it? But then I think now I'm doing ECC work. The tricky thing is is people have to pay because they're not regular clients. So you're seeing people from anywhere that might have any sort of financial background, you have no trust built up with them and no sort of client relationship that like those practices do make you pay before you leave. So I think I've now sort of got into the habit of talking about it anyway. So now whenever I do do GP work, because I still log them, I do tend to just have the discussion with them then and say, I'm really sorry, but if I know a horrible discussion to have right now, but if it's okay with you, if you if you can either pop to the counter or I can ask one of the reception team to come in here and to take a payment from you now before you go, and then it's just out of the way. And the majority of people are like, Yeah, yeah, no problem at all. I tend to find the people that argue with you are the ones that are probably not going to pay the bill anyway, in which case, if they get funny about it and they've asked for an individual cremation, I just say that's absolutely fine. If you want to take some time, that's no problem. But just to let you know, we'll have to hold your little love here and keep them comfortable until you have paid the bill, because we can't send them for an individual cremation until the bill is settled. And I say it in a really nice way, but I think it gives you that incentive because they know that they have to pay it, otherwise they're not going to get the dog back or the cat back. So I don't know. I think it's that fine line, isn't it, between being really nice to someone and trying to help them out in a time where it's really crap for them versus being a bit too nice and forgetting that we are a business and they still have to pay. It is tricky, isn't it? And I think, you know, like you get welfare euthanasia's come into it. And yes, if people have no money and it's dying in front of you, then fine, that's a different story, isn't it? But I think ultimately people know that they have to pay for euthanasia and the majority of time they're quoted a price over the phone before they even get to you. So they know what they're getting themselves in for.
SPEAKER_02The issue isn't the euthanasia, it's the body, isn't it? Because especially in out-of-hours practice, if you don't handle this right, you've got five, six, seven bodies in the freezer, and sometimes you can't even get hold of the client to decide is it individual, is it is it communal? Because if they haven't paid and they've they've stipulated or they've said we don't know at the time and they've not got back to you, it's a real management headache. So yeah, I think um in general practice it's less of an issue, but it still can be if you've got a really big body, um and it's a big c hit to the practice to pay for the cremation.
SPEAKER_06The only other thing I wanted to bring up here, which I've had a couple of people ask me and I've never known how to respond. Have you ever had it where someone's gone, you're not gonna put them in a bag, are you? Because I think people don't really think about what happens to the bodies, but sometimes they are aware that what might happen is they might get put in a bag and put in a freezer, which is obviously what happens to all of them. But people don't like to think about that. So I've had some people say to me before, Well, you're not gonna put them in a bag, are you? And I'm like, Well, CPC aren't connecting for like four days, so I'm not gonna leave it out on top of the freezer. So, but then what do you say? You can't be like, no, sorry, it's going in a bag and in the freezer, but then you can't lie. So I normally just say, Don't worry, we'll keep them nice and comfortable. Because what are you supposed to say?
SPEAKER_02You know, so I I say something like, keep them on their blanket for as long as possible. Um, but eventually, yeah, we do have to freeze them. So that that's how I how I kind of phrase it. So yeah, don't worry, won't you know?
SPEAKER_06Okay.
SPEAKER_02So that's my kind of go get out of yeah.
SPEAKER_06Uh it's horrible, isn't it? Because you don't want to tell people, yeah, yeah, they go in the freezer in a bag, but then like we we can't lie, can we? It's horrible. But yeah.
SPEAKER_02Yeah, but then I'll go out back and I'll say, just keep this one on the bed for as long as you can, and now and the staff will look at me and I'll go, you know, just because we said any idea, it could be five minutes, it could be an hour. I don't know how long it's gonna be. But we do do the best we can to try and I think this do you know. This came up with another conversation with a vet I was having where sometimes we have to follow certain rules, but I think as long as you can come across like you're listening and hearing what they're saying and you're trying your best, even if your best is they're gonna be on the bed for seven minutes, I think that gets you somewhere with the client, doesn't it? Because it's not then this rules thing. No, they have to go straight in the free. You know, we can kind of bend a little bit and still follow the rule, and I think we might gain a bit more affection from our clients.
SPEAKER_06Yeah, I don't know. It's a tricky conversation to have anyway. Okay, right, let's get to the exciting bit. We recently interviewed Francisco Gomez, an ophthalmology cert holder who runs a mobile ophthalmology service going between different clinics in both Spain and in the UK. So here's what he had to say. So, welcome, Francisco, to the podcast. Thank you very much for coming on board.
SPEAKER_00Hello.
SPEAKER_06Hello.
SPEAKER_00Thank you for having me.
SPEAKER_06Yeah, no worries. So, for people that don't know who you are, do you just want to start off a little uh with a little bit of an introduction about yourself, uh like where you live, where you work, what you do, etc.
SPEAKER_00Okay. Okay, so my name is Francisco, and most people call me Fran. I am an advanced practitioner in veterinary ophthalmology. I I have worked in the UK, uh well, I started to work in the UK in 2007 in first opinion practice, and eventually I became the clinical director of uh practice in uh Nottinghamshire. After that, uh COVID came, um, and that time I was uh trying to improve my ophthalmology. Ophthalmology is something I've been doing for quite a while, trying to get better at that. And um I did my certificate, I became an advanced practitioner, and then I got a job in a referral center for a couple of years. Uh, I think the the benefit is that I have had a lot of contact with first opinion, and then I have worked also in a place where I only do ophthalmology. So I can I can find the line in between. Often something that I I see is the referral world is a world that's miles apart from first opinion, and um that's where advanced practitioners should come in. So and I I think I I can help with that. So right now I I move to uh back to Spain where where I am originally from, I'm from Costa del Sol, even though people don't see it, but um because I am of pale skin, the rest of my family aren't. And then people used to ask me, your accent is not British. Are you Russian? I'm not Russian. So now I work in both the UK and Spain in Spain. I have my own business, it's called Ojo Veterinario, which means veterinary eye. And what I do is I see um referral in practice. So I go to practices, people who know me call me when they have an eye problem, they put me an appointment, and I go and see the patient as a referral in-house. And because I can do that as well, there is we don't have we don't have the 24-7 requirement from the RCBS in Spain. Therefore, I can actually take a weekend off and not provide the service if I don't, if I can't. Obviously, I would love to, but by myself I wouldn't be able to do it. And then every now and then I come back to the UK, see some family, see some friends, and then I do some first opinion uh work uh down here. So in Spain, what I have, I have one practice which is a friendly practice that has my microscope. So if I have to do surgery, that's where where I send people to. But the rest of the time, if I can do the surgery in situ in the practice, then I'll do it there.
SPEAKER_06You've worked in both referral level and you've worked in GP practice. What would you say that you would wish that GP vets knew how to do a little bit better in terms of regular eye cases that you might see?
SPEAKER_00So, do vets deal with eyes well? I think they they do. The problem is a lot of vets they complain to me in university they didn't teach me enough about ice. And I panic when they book me ice. I come in and then I know what to do, perhaps poor I am worried I don't like eyes. And I don't like eyes, it's a little bit like I don't like maths. If you have a poor math teacher, then the rest of your life you don't like maths. Oh, math is fantastic, you just have to have the right teacher. When I was a child, my math teacher was spending 45 minutes jogging and five minutes teaching. And then I love maths. So with ophthalmology, it's a bit like the same. Now I find That there are a lot of things that they can be done better. That's one of the reasons now it doesn't feel very forced, but I'm going to advertise a bit. So I I do have a Facebook group called Spots. S for sugar, P for Papa, O, A for Oscar, and D for Delta, and S for sugar again. So it's facebook.com forward slash groups forward forward slash spots. So pretty much what I do is I put uh small videos and short videos, short clips. I write things to help people think more than do. How should you do a symmetry test? It looks like quite simple, just to look at a symmetry test. But I see sometimes people who forget to do them or don't know how exactly to do them. You put it in you you're supposed to put it in the lateral lateral third of the lower eyelid.
SPEAKER_02Oh my gosh. I don't have to do the upper.
SPEAKER_00Now, do you know which number you're looking for with the simulative test?
SPEAKER_05You want 15 and over, right?
SPEAKER_00Yeah, you want 15 and over, correct. But the simultier test doesn't just tell you that. It tells you a lot more. It can't tell you whether you have some tearings, and sometimes you have more and you have a lot more in one eye. If you have an ulcer and you have like 22, then maybe that's normal. But what happens if you have an ulcer and you have 15? Yeah, but you should expect more, don't you? Yeah. So that is what you're thinking. Okay, do we have a patient that, yes, I have an ulcer? Maybe the dry eye is not caused of the ulcer, but we know that maybe lubrication in the eye is not that great. You know, things like that. Do you do both eyes when you do a symmetia test?
SPEAKER_02Yes, most of the time. Every now and then. Yeah.
SPEAKER_00Yes, do both. And you'll notice as well that often the other eye has a lower reading. And the other eye has a lower reading, not because it's got a dry eye, it's simply a response. It's a it's a pain response from the other eye. And it doesn't mean so. Don't underdiagnose dry eye because very often I see people that because you know they are unsure what how to deal with things, that they have an eye that they've been treating with antibiotics for three weeks. They've gone from vet to another vet and they've been changing antibiotics. When actually bacterial conjuntivitis in dogs is very rare. What they actually seen is a dog with dry eye and they've been three weeks treating it, and nobody's done a similar T test. Then you do it, and then you have two jobs. One of the jobs is, you have three jobs. One of the jobs is to tell the vet, maybe try this. The second job is to tell the owner without causing trouble to the vet, telling the owner that maybe he spent 150 pounds already in something that could be done in the first appointment. So you know, sometimes you have to um to work a tight drop, you call it. Like you it's difficult. I said three things. I can't remember the other one. You have to treat the patient, don't, don't you?
SPEAKER_02Yeah. Do you know when you're when you're saying that though, you really got me thinking, because can you sometimes get a falsely dry eye if it's a conjunctivitis? Like a ha ha. You said it's rare, you see. So maybe a bacterial conjunctivitis is a but you maybe you've got some kind of yellow ocular discharge, you do a sterbo tear test and it's low. Could it be falsely low and then you do some lubrication and or some naughty antibiotics and then retest in a week? Is that a thing or not really?
SPEAKER_00It depends. When you have one of the things we do with um simulator test is when you do it, you do it pretty much before you do a lot more. Anything that can cause the eye to tear, then you may want to avoid it. So when I see a patient, if I have the time, I understand that you know, in referral practice, I used to have one hour to see my patient. In first opinion, I have 15 minutes, not always. So when the patient comes in, I already see behavior, already I'm looking at that. And I do look at eyes more than anything, but because it's what I do. But we I think we all do that. We we're talking to the client, but we're actually looking at the pet. We're having a child, we say, How are you? But you're actually not paying attention to the conversation. You're actually having a lot of look at the pet. So in the same way, I can see what is it opening to things, is it the eye looks a bit red? Is it and and then the next thing that I do is I get a bit of history, and I see whether the dog eyes, I do a bit of a menace response, you know, with the dog because you want to know whether the pet sees or not. But pretty much the next thing I'm gonna do is gonna be the symmetria test. I combine this with neuroophthalmology, which is your, you know, your your tassel and your PLR and that. But to do that, you're gonna have to put some lights on the eye, you're gonna make the eye tear a little bit. So I tend to do the simia test before that. It may not make a big difference, but I try to follow a step by step, you know. And then reasons for dry eye, there are many. The most common that we know is immunomediated. You see, like, you know, these small breeds usually with lowish tear production. And remember, it's the equals, it's not, you know, the tear has the tear has two layers, and you're actually looking at the equals. Um so and that's the reason sometimes it looks like an infection, because you see, the tear has a musin and it has that lipid layer as well, produced by the mayobimian glands. So if you are losing the equals, what you are left with is with a bit of a thicken, muco purulin-like thing that many people confuse with infection. Right. And usually bilateral, but you could have dry eye for several things. You could have a dry eye caused by toxicity, for instance. Did you know paracetamol can cause dry eye? No, I didn't know. It's not that common. We put a lot of pets on paracetamol, a lot of dogs. But it can cause it. Is that it causes a permanent dry eye or a transit? Usually, yeah, usually. I haven't seen it done often, but when I seen it, I haven't seen them recover it. And when you use, when you find a similar PIA test of zero with only unilateral, they usually this pet presents with an ulcer as well. And then they have that side of the nose try, then you have a neurogenic dry eye, you have completely different, uh completely different treatment. And then with there are other things, you know, there are there are a few causes for dry eye. And then you also have the treatment, the common treatment that we use with uh cyclosporine, it doesn't work at the beginning. You have to keep going for a couple of months sometimes to actually, while you actually helping put in some um tea artificial tears uh to help out. So some people they give it three weeks and they say, Well, this is not working, I'm gonna stop because this tube is so expensive.
SPEAKER_05Yeah.
SPEAKER_00Counseling the owner is is is important as well. And and we just talking dry eye. And most people that I meet, the only thing they understand from dry eye, or they actually tell me they understand from dry eye, yeah, some dogs have dry eye, the shimmer test is low, I'm just gonna put it in cyclosporine. That's not the end of it. There is a lot more. See, yeah. Patients who who don't um they don't respond that you have to use alternative medication. There is a lot. So yeah, ophthalmology is actually very cool, but if you don't know, then you'll be scared of it. It's a bit like um, you know, me being scared of orthopedics. Yeah, yeah. Even if I used to do crucial ligaments and that, but you know, that's that's because I'm old.
SPEAKER_02Yeah. I wanted to ask, every practice I go to for a like a simple corneal ulcer, we have remend on the shelf. The remend for the ulcer. Is that the best product for an ulcer? Or is it just marketing?
SPEAKER_00It depends what is causing your ulcer, right? Go on. You don't normally know, do you? What can cause an ulcer? I mean, one of the things we have, having um a product with ialuronic acid is a good thing. It's proven that ialonic acid have a lot of time of residency on the corneal surface. So as an artificial tear is it's a good thing. It helps. I would use it. Now, how often do we need to use it? And do you really need to use it? If you have an eye that is already properly lubricated, do you really need to use it that much? You know, first thing that people do with an ulcer is put an antibiotic. Correct. I'm not gonna stop that. Even though there is a paper, I think from last year, where says that non-infected ulcers don't need antibiotics. Okay. I'm not there yet. At the moment, I'm too scared. I'll if I see a patient every day, I maybe I would I would risk that. But um but an ulcer can get complicated very, very quickly. So, my opinion right now in 2026 is I'm using an antibiotic. Okay. Now, which antibiotic are you using? So take a sample. Do you take a sample for from the cornea? Do you know how to take a sample from the cornea? No.
SPEAKER_04I don't think anyone takes a sample.
SPEAKER_00Really?
SPEAKER_04Most people don't, do they?
SPEAKER_00Okay, so visit my group in Facebook, you know, and there is a free short clip of how to how to do that. And then you know which antibiotic to use.
SPEAKER_06You know, it's it's do you have a preference over of like ointment over watery drops?
SPEAKER_00Yes. I prefer ointments most of the time because they stay there for longer. So let's say we're going to use chloramphenicol that I don't have in Spain at the moment.
SPEAKER_06No way.
SPEAKER_00We all use we don't have chlorophyll. I it's difficult to to to get and justify also antibiotic use in Spain anyway. But if you use chloramphenicol eye drops, you'll use it four times a day. If you use ointment, you'll use it three times a day. Now, one thing is again counseling to the owners. I tell owners don't put the eye drop or the ointment on the cornea. Try to put it on the pocket, on the conjunct type. Just make the eye blink because the cornea has a lot of nerve endings. The dog or the cat hates it. So try to make sure your patient doesn't hate it, because if your patient doesn't hate it, you're not gonna have very good compliance. Now, ointment lasts lasts longer, so I would prefer it. However, if you have a risk of perforation, potentially an ointment is not the best thing to use. That's when you're thinking, well, in that case, I'm gonna use drops. Okay. But then it's also depending on the dexterity of the of the bed owner, some of them find drops easier. Some of them not, some of them prefer prefer ointment. So that and that is a case of infection. But most causes that I see in eye ulcer are not caused by infection. They are infected, and then the infection is one of the reasons the ulcer is not healing. But they are not being caused by infection in the first place. They have been caused by other things like exposure. Some pets actually sleep with their eyes open. Then the the tear evaporates, and then you have an erosion on the axial cornea in the center. And then, you know, that's when the ulcer starts. Often this happens to brightencephalics, you know. That's one of the causes of ulcer. But there are others. You know, a young dog could have uh an ectopic cilia underneath the underneath the upper eyelid. That's another thing. I'm going to branch into things. Ectopic cilia, dystichia, and tritiasis are not the same thing. Each one starts from one different place. That's very important because knowing which one's which, then it can tell you what is likely to be causing a problem or not, or what you're seeing is just an accident. It's not really true, it's just there and making you think, oh, this is causing the problem. For example, a dystichia comes from the edge of the eyelid, from the orifice of the Maybobian gland. If a dog is eight years old, eight, and he has an ulcer, and he has a dystichia at the same time, it's very unlikely that dystichia is causing the ulcer. Why? Because the dystichia has been there for eight years. Why is it causing an ulcer now? If a young dog has an ectopic cilia, those are the ones underneath the upper eyelid, then they could have very painful eyes, usually of a vertical shape, and they can be very painful. So those things come to knowledge, but that knowledge has to come from studying. And if studying that knowledge is painful and boring, then you say, I don't like eyes. Is it easy?
SPEAKER_02Is it easy for you to run through because the sticky eye and ectophicili always scare me a little bit because I feel like I could miss them because but is there certain breeds that you go, you're already breeds and age that you make you go, wow, that's likely.
SPEAKER_00Yes, there are, and I I don't remember Brit ever. I do see them distchius in labradors and that, but I I I don't tend to remember them. But pretty much breeds with uh tracheas. Tricheasis is um hairs from from the skin, from the actual skin. So tracheasis when those hairs come from from the normal skin. So most of the time tracheasis come from entroctum. When you have a distia, yes, it's from the memorial gland. You put your uh ophthalmoscope, if you don't have a slit lamp, you put ophthalmoscope at um at 20, um and then look through the orifice, and then you go through all the eye, the the eyelid, all the length, and see each one of the you you can even count them with that. It'll be 20 or 22 on each side, uh, and see where there are hairs coming from there. Those would be the sticky yes. Uh and and then the inside is these are more difficult to uh to find because some sometimes are very, very small, are the ectopic cilia. I said to you, put your ophthalmoscope at 20. Do you know what that 20 means?
SPEAKER_05It's the 20 once you when you turn it, isn't it? I don't know what it means. What's that 20?
SPEAKER_00What does 20 about?
SPEAKER_02I just wiggle it around until I see what I want to say. Until you see what I'm saying. It's really bad, yeah. Yeah.
SPEAKER_06Aren't you supposed to be able to start at zero and work your way through and it pans through the idea? I never remember which way it goes.
SPEAKER_00Do you know what the 15, 20, 10? What what does it mean? No. No, no idea. It's very easy and very fun. So pretty much is one divided by 20. Is one meter divided by 20 is 5 centimeters, right? Right. So the 20 is 5 city, okay. 1 divided by 20 is equal five. Yes. You know, 1 meter is 100 centimeters divided by 20 centimeters would be 5. So the 20 is telling you that you're going to have the focus of 5 centimeters from your uh from from the thing. So it was 15, it'll be a hundred or one meter, a hundred centimeters divided by 15, and that number is the number of centimeters where you have the focus from your ophthalmoscope.
SPEAKER_02Oh. So as the numbers go down, your focus focal point is further away from your optimal scope.
SPEAKER_00Yes. And this the zero is when you look at the at the fundus, right? And zero, one divided by zero is infinite. So there is no there is no bending of the light. So if you actually look through your ophthalmoscope, through your room, nothing would have changed, nothing would change because it's not bending the light.
unknownYeah.
SPEAKER_05I feel like if I we'd have learned this at Looney, Looney eyes would make much more sense.
SPEAKER_00Because I feel like they just get to the case.
SPEAKER_05Hold this up, put your eye on it and have a look.
SPEAKER_00Yeah. And it tells you a number.
SPEAKER_02For this one is this number. But the other thing they do is they turn all the lights down and make you look at slides, and then you fall asleep. It's really bad to admit that. But do you know what's very funny?
SPEAKER_00When I start my uh my consultation of ophthalmology, I start with the lights on. But then at a certain point, after I talk to the owner, it's on history, do a little bit of uh neuroophthalmology and your um uh and your uh shimmer test, then I actually put switch the lights off to actually properly test um the cell PLR and actually look with the slit lamp or with the ophthalmoscope. When I make the room dark, people stop talking and they start like murmuring, like uh talking very low. Like we're going to wait. Yeah, whispering, exactly. That's the word. Yeah, like whispering. I'm thinking, we we all hear, nobody's going to sleep. That's we're not whispering, but for some reason in our brain, we think in that light whisper. Yeah. Okay. Yeah. Yeah. True. Uh anyways. So all those things, you know, you can find in my group. And then what I do is every couple of months or whatever, when I have the time to do it, then I sell because it's a C paid for CPD, because it takes me forever to do it. So uh and uh I do is an online interactive session. Okay. And then in that interactive session is usually a small amount, a small amount of people, like 10, 12 people maximum, never more. So everyone has the opportunity to chat. And then I go through a case. I don't give the answer, I just go through it and I keep asking questions through it. The people can uh can chat, can talk. Some people are happy to chat. Some people don't want to chat, they just write on the on the on the chat um uh anonymously. I allow people to be themselves. Something that used to something that I have found that uh made my learning more difficult is that I was afraid of asking a stupid question. It's always been a thing to me. I am not afraid of asking stupid questions anymore. And I don't think you should be, because that just delayed your learning. So if someone give me ask me a stupid question, I'm not gonna take it as stupid. I'm gonna take it as you want to know, I'm gonna tell you. You know, humbly, I am still learning.
SPEAKER_02We love chatting to Francisco. He was so much fun and a really interesting person to chat to. So we hope you enjoyed the conversation as much as we did.
SPEAKER_06Yeah, he's he's got that really cool community as well, remember, on Facebook that he mentioned too. So check out the link on our show notes if you're interested in looking at SBOD's his Facebook page discussing all things opt out and talking through cases, having small CPD sessions, etc. So check it out if you're interested.
SPEAKER_02Okay, so yeah, time to round up. Um we've covered loads today from neutering debates to euthanasia, payment discussions, and ophthalmology in general practice.
SPEAKER_06Yeah, 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. And remember, you've got the blog, you've got our WhatsApp number, and you've got socials to contact us through now. So there's no excuse. Please get in touch.
SPEAKER_02And I know as soon as you hear Charlotte saying that, about 50% of you are just dropping off and pressing the stop button now. But anyway, I'll say, yes, absolutely. But for now, thank you for listening. Join us again next Sunday for our extra bonus episode of the month, um, where we're going to be talking about all things regenerative medicine with our special, extra special guest. We can't wait.
SPEAKER_06Yeah, we honestly can't wait. It's gonna be such a good one. So we hope you're looking forward to it just as much as we are. So keep an eye out on our socials in the meantime for updates. But until then, it's bye from me.
SPEAKER_02And bye from me. Take care. This podcast is intended for licensed pet from professionals and is provided for educational and discussion purposes only. Whilst it is publicly accessible, it is not intended as advice for pet owners.
SPEAKER_06The views shared are based on our own clinical experience and interpretation and do not replace individual clinical judgment. We accept no responsibility for decisions made based on this content, and all cases should be assessed on an individual basis.
SPEAKER_02Any references to medications, treatments, or products are made for educational discussion only and are not intended to promote or advertise veterinary medicines to the general public. Veterinary medicine should only be used under the direction of a prescribing veteran surgeon and in accordance with the UK veterinary medicine regulations.
