{"version":"1.0.0","segments":[{"speaker":"Nathalie Dowgray","startTime":4.95,"endTime":7.92,"body":"Hello welcome"},{"speaker":"Nathalie Dowgray","startTime":4.95,"endTime":7.92,"body":"to the February 2023 episode of"},{"speaker":"Nathalie Dowgray","startTime":7.92,"endTime":12.0,"body":"Chattering With ISFM. I'm"},{"speaker":"Nathalie Dowgray","startTime":7.92,"endTime":12.0,"body":"Nathalie Dowgray, head of ISFM"},{"speaker":"Nathalie Dowgray","startTime":12.12,"endTime":15.12,"body":"and host of this month's"},{"speaker":"Nathalie Dowgray","startTime":12.12,"endTime":15.12,"body":"podcast. This month we're"},{"speaker":"Nathalie Dowgray","startTime":15.12,"endTime":17.79,"body":"sharing the first of our 'In"},{"speaker":"Nathalie Dowgray","startTime":15.12,"endTime":17.79,"body":"Conversations With' sessions."},{"speaker":"Nathalie Dowgray","startTime":17.97,"endTime":21.27,"body":"These were recorded live at our"},{"speaker":"Nathalie Dowgray","startTime":17.97,"endTime":21.27,"body":"Rhodes Congress last year. We're"},{"speaker":"Nathalie Dowgray","startTime":21.27,"endTime":23.94,"body":"going to be sharing the"},{"speaker":"Nathalie Dowgray","startTime":21.27,"endTime":23.94,"body":"discussion that ISFM's own Dr."},{"speaker":"Nathalie Dowgray","startTime":23.94,"endTime":27.18,"body":"Sam Taylor had with Professor"},{"speaker":"Nathalie Dowgray","startTime":23.94,"endTime":27.18,"body":"Clare Rusbridge, and they were"},{"speaker":"Nathalie Dowgray","startTime":27.18,"endTime":30.78,"body":"speaking about neuropathic pain."},{"speaker":"Nathalie Dowgray","startTime":27.18,"endTime":30.78,"body":"We're also featuring our monthly"},{"speaker":"Nathalie Dowgray","startTime":30.81,"endTime":33.66,"body":"JFMS clinical spotlight"},{"speaker":"Nathalie Dowgray","startTime":30.81,"endTime":33.66,"body":"interview. This month, I'm"},{"speaker":"Nathalie Dowgray","startTime":33.66,"endTime":36.27,"body":"speaking with Dr. Alix Freeman"},{"speaker":"Nathalie Dowgray","startTime":33.66,"endTime":36.27,"body":"about feline mandibular"},{"speaker":"Nathalie Dowgray","startTime":36.27,"endTime":38.88,"body":"fractures. We hope you enjoy"},{"speaker":"Nathalie Dowgray","startTime":36.27,"endTime":38.88,"body":"this episode."},{"speaker":"Sam Taylor","startTime":43.44,"endTime":45.81,"body":"Hi, everybody, thank"},{"speaker":"Sam Taylor","startTime":43.44,"endTime":45.81,"body":"you so much for joining us for"},{"speaker":"Sam Taylor","startTime":45.81,"endTime":49.86,"body":"our in conversation session. You"},{"speaker":"Sam Taylor","startTime":45.81,"endTime":49.86,"body":"all know Clare, she is an RCVS"},{"speaker":"Sam Taylor","startTime":49.86,"endTime":53.91,"body":"and European specialist in"},{"speaker":"Sam Taylor","startTime":49.86,"endTime":53.91,"body":"veterinary neurology. And we're"},{"speaker":"Sam Taylor","startTime":53.91,"endTime":57.51,"body":"here to talk about neuropathic"},{"speaker":"Sam Taylor","startTime":53.91,"endTime":57.51,"body":"pain. So, I'll open that up by"},{"speaker":"Sam Taylor","startTime":57.51,"endTime":59.67,"body":"asking you what is neuropathic"},{"speaker":"Sam Taylor","startTime":57.51,"endTime":59.67,"body":"pain?"},{"speaker":"Clare Rusbridge","startTime":59.73,"endTime":62.28,"body":"We really"},{"speaker":"Clare Rusbridge","startTime":59.73,"endTime":62.28,"body":"recognise three different types"},{"speaker":"Clare Rusbridge","startTime":62.28,"endTime":65.46,"body":"of pain. And you have to"},{"speaker":"Clare Rusbridge","startTime":62.28,"endTime":65.46,"body":"remember the purpose of pain is"},{"speaker":"Clare Rusbridge","startTime":65.46,"endTime":71.1,"body":"a protective response to protect"},{"speaker":"Clare Rusbridge","startTime":65.46,"endTime":71.1,"body":"you from injury. So, the"},{"speaker":"Clare Rusbridge","startTime":72.06,"endTime":76.77,"body":"simplest type of pain is your"},{"speaker":"Clare Rusbridge","startTime":72.06,"endTime":76.77,"body":"simple nociceptive response. So,"},{"speaker":"Clare Rusbridge","startTime":76.77,"endTime":80.64,"body":"you walk across the floor, you"},{"speaker":"Clare Rusbridge","startTime":76.77,"endTime":80.64,"body":"stand on a tack, you realise"},{"speaker":"Clare Rusbridge","startTime":80.64,"endTime":83.76,"body":"that the tack is there that your"},{"speaker":"Clare Rusbridge","startTime":80.64,"endTime":83.76,"body":"foot is injured, this"},{"speaker":"Clare Rusbridge","startTime":83.79,"endTime":87.0,"body":"information is relayed to your"},{"speaker":"Clare Rusbridge","startTime":83.79,"endTime":87.0,"body":"brain without you having to make"},{"speaker":"Clare Rusbridge","startTime":87.15,"endTime":90.84,"body":"any adjustments, you will"},{"speaker":"Clare Rusbridge","startTime":87.15,"endTime":90.84,"body":"withdraw your foot, but you have"},{"speaker":"Clare Rusbridge","startTime":90.84,"endTime":94.65,"body":"this conscious perception of"},{"speaker":"Clare Rusbridge","startTime":90.84,"endTime":94.65,"body":"pain, it makes you have a"},{"speaker":"Clare Rusbridge","startTime":94.65,"endTime":98.55,"body":"behavioural change to take your"},{"speaker":"Clare Rusbridge","startTime":94.65,"endTime":98.55,"body":"action. The next type of pain is"},{"speaker":"Clare Rusbridge","startTime":98.58,"endTime":102.66,"body":"inflammatory pain. So, the"},{"speaker":"Clare Rusbridge","startTime":98.58,"endTime":102.66,"body":"inflammatory mediators are"},{"speaker":"Clare Rusbridge","startTime":102.69,"endTime":106.74,"body":"released. So, we say the first"},{"speaker":"Clare Rusbridge","startTime":102.69,"endTime":106.74,"body":"stages of osteoarthritis, and"},{"speaker":"Clare Rusbridge","startTime":106.74,"endTime":110.85,"body":"then that starts your pain"},{"speaker":"Clare Rusbridge","startTime":106.74,"endTime":110.85,"body":"process. Neuropathic pain"},{"speaker":"Clare Rusbridge","startTime":111.03,"endTime":115.71,"body":"implies abnormal processing of"},{"speaker":"Clare Rusbridge","startTime":111.03,"endTime":115.71,"body":"that pain information either in"},{"speaker":"Clare Rusbridge","startTime":115.71,"endTime":119.46,"body":"the peripheral level or at a"},{"speaker":"Clare Rusbridge","startTime":115.71,"endTime":119.46,"body":"central level. So, it implies"},{"speaker":"Clare Rusbridge","startTime":119.46,"endTime":124.05,"body":"there's been some maladaptive"},{"speaker":"Clare Rusbridge","startTime":119.46,"endTime":124.05,"body":"synaptic plasticity to mean that"},{"speaker":"Clare Rusbridge","startTime":124.05,"endTime":129.12,"body":"you have an abnormal perception"},{"speaker":"Clare Rusbridge","startTime":124.05,"endTime":129.12,"body":"of pain, so that impulses that"},{"speaker":"Clare Rusbridge","startTime":129.12,"endTime":133.5,"body":"should not be painful, are"},{"speaker":"Clare Rusbridge","startTime":129.12,"endTime":133.5,"body":"perceived as painful. One of the"},{"speaker":"Clare Rusbridge","startTime":133.5,"endTime":136.44,"body":"problems we have with pain"},{"speaker":"Clare Rusbridge","startTime":133.5,"endTime":136.44,"body":"really is it's a very subjective"},{"speaker":"Clare Rusbridge","startTime":136.68,"endTime":140.49,"body":"experience. So in humans, we’ll"},{"speaker":"Clare Rusbridge","startTime":136.68,"endTime":140.49,"body":"often describe neuropathic pain"},{"speaker":"Clare Rusbridge","startTime":140.52,"endTime":145.77,"body":"as burning, or electric shocks,"},{"speaker":"Clare Rusbridge","startTime":140.52,"endTime":145.77,"body":"or other sensory perceptions"},{"speaker":"Clare Rusbridge","startTime":145.77,"endTime":148.23,"body":"that you wouldn't normally"},{"speaker":"Clare Rusbridge","startTime":145.77,"endTime":148.23,"body":"associate with pain, like ice"},{"speaker":"Clare Rusbridge","startTime":148.23,"endTime":153.42,"body":"cold, animals can't do that. And"},{"speaker":"Clare Rusbridge","startTime":148.23,"endTime":153.42,"body":"so you make, you often make a"},{"speaker":"Clare Rusbridge","startTime":153.42,"endTime":156.15,"body":"lot of assumptions when we're"},{"speaker":"Clare Rusbridge","startTime":153.42,"endTime":156.15,"body":"talking about neuropathic pain"},{"speaker":"Clare Rusbridge","startTime":156.15,"endTime":159.78,"body":"in animals. And it makes it very"},{"speaker":"Clare Rusbridge","startTime":156.15,"endTime":159.78,"body":"difficult to diagnose."},{"speaker":"Sam Taylor","startTime":159.78,"endTime":161.73,"body":"What will the owners"},{"speaker":"Sam Taylor","startTime":159.78,"endTime":161.73,"body":"notice? Is it always self"},{"speaker":"Sam Taylor","startTime":161.73,"endTime":163.56,"body":"mutilation type things? Or?"},{"speaker":"Clare Rusbridge","startTime":163.75,"endTime":165.82,"body":"Well,"},{"speaker":"Clare Rusbridge","startTime":163.75,"endTime":165.82,"body":"neuropathic pain is classically"},{"speaker":"Clare Rusbridge","startTime":165.82,"endTime":169.81,"body":"where they are mutilating"},{"speaker":"Clare Rusbridge","startTime":165.82,"endTime":169.81,"body":"possibly, although, we have to"},{"speaker":"Clare Rusbridge","startTime":169.81,"endTime":174.91,"body":"be very careful when we say"},{"speaker":"Clare Rusbridge","startTime":169.81,"endTime":174.91,"body":"mutilation because we don't know"},{"speaker":"Clare Rusbridge","startTime":174.91,"endTime":178.72,"body":"what's driving them. Neuropathic"},{"speaker":"Clare Rusbridge","startTime":174.91,"endTime":178.72,"body":"pain is actually very difficult"},{"speaker":"Clare Rusbridge","startTime":178.75,"endTime":184.0,"body":"to diagnose. Because you don't,"},{"speaker":"Clare Rusbridge","startTime":178.75,"endTime":184.0,"body":"it is subjective and you don't"},{"speaker":"Clare Rusbridge","startTime":184.0,"endTime":187.84,"body":"have that descriptive element."},{"speaker":"Clare Rusbridge","startTime":184.0,"endTime":187.84,"body":"And you really have to base it"},{"speaker":"Clare Rusbridge","startTime":187.84,"endTime":192.16,"body":"on the animal's behavioural"},{"speaker":"Clare Rusbridge","startTime":187.84,"endTime":192.16,"body":"response, and hopefully some"},{"speaker":"Clare Rusbridge","startTime":192.19,"endTime":194.35,"body":"evidence of neurological"},{"speaker":"Clare Rusbridge","startTime":192.19,"endTime":194.35,"body":"injuries."},{"speaker":"Sam Taylor","startTime":194.38,"endTime":196.72,"body":"One of the struggles"},{"speaker":"Sam Taylor","startTime":194.38,"endTime":196.72,"body":"is identifying neuropathic pain"},{"speaker":"Sam Taylor","startTime":196.72,"endTime":199.72,"body":"and distinguishing it from"},{"speaker":"Sam Taylor","startTime":196.72,"endTime":199.72,"body":"emotional distress. Do you have"},{"speaker":"Sam Taylor","startTime":199.72,"endTime":200.38,"body":"any tips?"},{"speaker":"Clare Rusbridge","startTime":200.48,"endTime":204.32,"body":"Well, you have"},{"speaker":"Clare Rusbridge","startTime":200.48,"endTime":204.32,"body":"to take a very good history, the"},{"speaker":"Clare Rusbridge","startTime":204.35,"endTime":209.12,"body":"cortical limbic system processes"},{"speaker":"Clare Rusbridge","startTime":204.35,"endTime":209.12,"body":"pain, and the cortical limbic"},{"speaker":"Clare Rusbridge","startTime":209.12,"endTime":212.21,"body":"system processes emotion, there"},{"speaker":"Clare Rusbridge","startTime":209.12,"endTime":212.21,"body":"is an overlap between the two."},{"speaker":"Clare Rusbridge","startTime":212.39,"endTime":215.12,"body":"And painful conditions are more"},{"speaker":"Clare Rusbridge","startTime":212.39,"endTime":215.12,"body":"likely to result in behavioural"},{"speaker":"Clare Rusbridge","startTime":215.12,"endTime":219.65,"body":"problems, and emotion based"},{"speaker":"Clare Rusbridge","startTime":215.12,"endTime":219.65,"body":"problems are more likely to"},{"speaker":"Clare Rusbridge","startTime":219.65,"endTime":224.12,"body":"trigger pain syndromes or make"},{"speaker":"Clare Rusbridge","startTime":219.65,"endTime":224.12,"body":"them worse. And so, whenever"},{"speaker":"Clare Rusbridge","startTime":224.12,"endTime":227.87,"body":"you're investigating one of"},{"speaker":"Clare Rusbridge","startTime":224.12,"endTime":227.87,"body":"these conditions, you have to"},{"speaker":"Clare Rusbridge","startTime":228.08,"endTime":232.46,"body":"investigate the environment of"},{"speaker":"Clare Rusbridge","startTime":228.08,"endTime":232.46,"body":"the cat. Even when you come in"},{"speaker":"Clare Rusbridge","startTime":232.46,"endTime":238.76,"body":"with preconceptions about it, it"},{"speaker":"Clare Rusbridge","startTime":232.46,"endTime":238.76,"body":"is tedious to try to explore"},{"speaker":"Clare Rusbridge","startTime":238.76,"endTime":243.5,"body":"that in a 5 or 10 minute"},{"speaker":"Clare Rusbridge","startTime":238.76,"endTime":243.5,"body":"consultation, it does need to be"},{"speaker":"Clare Rusbridge","startTime":243.53,"endTime":247.19,"body":"explored, you need to send the"},{"speaker":"Clare Rusbridge","startTime":243.53,"endTime":247.19,"body":"owner away with homework to"},{"speaker":"Clare Rusbridge","startTime":247.19,"endTime":251.24,"body":"explore it in a kind of non"},{"speaker":"Clare Rusbridge","startTime":247.19,"endTime":251.24,"body":"threatening way to the owner, I"},{"speaker":"Clare Rusbridge","startTime":251.24,"endTime":254.78,"body":"create some kind of"},{"speaker":"Clare Rusbridge","startTime":251.24,"endTime":254.78,"body":"questionnaire that we would use"},{"speaker":"Clare Rusbridge","startTime":254.78,"endTime":256.97,"body":"or get the owner to video that"},{"speaker":"Clare Rusbridge","startTime":254.78,"endTime":256.97,"body":"sort of thing."},{"speaker":"Sam Taylor","startTime":257.75,"endTime":259.22,"body":"What are your"},{"speaker":"Sam Taylor","startTime":257.75,"endTime":259.22,"body":"treatment options for"},{"speaker":"Sam Taylor","startTime":259.22,"endTime":260.48,"body":"neuropathic pain?"},{"speaker":"Clare Rusbridge","startTime":260.0,"endTime":262.629,"body":"So you get"},{"speaker":"Clare Rusbridge","startTime":260.0,"endTime":262.629,"body":"these synaptic changes that"},{"speaker":"Clare Rusbridge","startTime":262.698,"endTime":266.574,"body":"basically mean that one"},{"speaker":"Clare Rusbridge","startTime":262.698,"endTime":266.574,"body":"neurotransmitter is really going"},{"speaker":"Clare Rusbridge","startTime":266.643,"endTime":271.003,"body":"a long way in those cases, and"},{"speaker":"Clare Rusbridge","startTime":266.643,"endTime":271.003,"body":"that is synaptic windup. So when"},{"speaker":"Clare Rusbridge","startTime":271.072,"endTime":275.086,"body":"we are treating neuropathic"},{"speaker":"Clare Rusbridge","startTime":271.072,"endTime":275.086,"body":"pain, you have to think that's"},{"speaker":"Clare Rusbridge","startTime":275.155,"endTime":279.307,"body":"what we are treating. And when"},{"speaker":"Clare Rusbridge","startTime":275.155,"endTime":279.307,"body":"really, when we use drugs for"},{"speaker":"Clare Rusbridge","startTime":279.376,"endTime":283.46,"body":"treating neuropathic pain, I"},{"speaker":"Clare Rusbridge","startTime":279.376,"endTime":283.46,"body":"have to say there are very few"},{"speaker":"Clare Rusbridge","startTime":283.529,"endTime":288.027,"body":"drugs, and none of them that are"},{"speaker":"Clare Rusbridge","startTime":283.529,"endTime":288.027,"body":"available for cats that are used"},{"speaker":"Clare Rusbridge","startTime":288.096,"endTime":292.041,"body":"directly to treat neuropathic"},{"speaker":"Clare Rusbridge","startTime":288.096,"endTime":292.041,"body":"pain, with the exception of"},{"speaker":"Clare Rusbridge","startTime":292.11,"endTime":296.608,"body":"Solensia. That is our only drug."},{"speaker":"Clare Rusbridge","startTime":292.11,"endTime":296.608,"body":"There's nothing else that's ever"},{"speaker":"Clare Rusbridge","startTime":296.677,"endTime":300.968,"body":"been developed that is actually"},{"speaker":"Clare Rusbridge","startTime":296.677,"endTime":300.968,"body":"to treat neuropathic pain. All"},{"speaker":"Clare Rusbridge","startTime":301.037,"endTime":305.259,"body":"of the other ones are what we"},{"speaker":"Clare Rusbridge","startTime":301.037,"endTime":305.259,"body":"call adjunctive drugs that were"},{"speaker":"Clare Rusbridge","startTime":305.328,"endTime":309.48,"body":"borrowed from other things, and"},{"speaker":"Clare Rusbridge","startTime":305.328,"endTime":309.48,"body":"we've got the sodium channel"},{"speaker":"Clare Rusbridge","startTime":309.549,"endTime":313.355,"body":"blockers and things like"},{"speaker":"Clare Rusbridge","startTime":309.549,"endTime":313.355,"body":"lidocaine which I use a lot in"},{"speaker":"Clare Rusbridge","startTime":313.425,"endTime":317.162,"body":"various different forms, either"},{"speaker":"Clare Rusbridge","startTime":313.425,"endTime":317.162,"body":"as a CRI or as a local"},{"speaker":"Clare Rusbridge","startTime":317.231,"endTime":321.314,"body":"anaesthetic, right down to"},{"speaker":"Clare Rusbridge","startTime":317.231,"endTime":321.314,"body":"amitriptyline, which we use more"},{"speaker":"Clare Rusbridge","startTime":321.383,"endTime":325.535,"body":"regularly in cats. I don't, it"},{"speaker":"Clare Rusbridge","startTime":321.383,"endTime":325.535,"body":"tastes foul and they hate it."},{"speaker":"Clare Rusbridge","startTime":325.604,"endTime":330.033,"body":"Owners hate it more because they"},{"speaker":"Clare Rusbridge","startTime":325.604,"endTime":330.033,"body":"tried to give it to the cat and"},{"speaker":"Clare Rusbridge","startTime":330.103,"endTime":334.116,"body":"it foams everywhere. I love my"},{"speaker":"Clare Rusbridge","startTime":330.103,"endTime":334.116,"body":"dexdomitor for pain relief."},{"speaker":"Clare Rusbridge","startTime":334.186,"endTime":337.923,"body":"Absolutely love it. And of"},{"speaker":"Clare Rusbridge","startTime":334.186,"endTime":337.923,"body":"course, we have opioids. So"},{"speaker":"Clare Rusbridge","startTime":337.992,"endTime":342.213,"body":"these are the sort of drugs that"},{"speaker":"Clare Rusbridge","startTime":337.992,"endTime":342.213,"body":"we have available to us. The"},{"speaker":"Clare Rusbridge","startTime":342.283,"endTime":346.504,"body":"ones that I use actually depend"},{"speaker":"Clare Rusbridge","startTime":342.283,"endTime":346.504,"body":"on the condition. So they may"},{"speaker":"Clare Rusbridge","startTime":346.573,"endTime":350.449,"body":"respond to Gabapentin and"},{"speaker":"Clare Rusbridge","startTime":346.573,"endTime":350.449,"body":"pregabalin. But actually, they"},{"speaker":"Clare Rusbridge","startTime":350.518,"endTime":354.324,"body":"do surprisingly well on"},{"speaker":"Clare Rusbridge","startTime":350.518,"endTime":354.324,"body":"phenobarbital and that often is"},{"speaker":"Clare Rusbridge","startTime":354.393,"endTime":358.822,"body":"more effective than those drugs."},{"speaker":"Clare Rusbridge","startTime":354.393,"endTime":358.822,"body":"There will be some cases that I"},{"speaker":"Clare Rusbridge","startTime":358.891,"endTime":362.905,"body":"will use that on. An advantage"},{"speaker":"Clare Rusbridge","startTime":358.891,"endTime":362.905,"body":"of phenobarbital is also is"},{"speaker":"Clare Rusbridge","startTime":362.974,"endTime":367.127,"body":"like, I'll often try it once"},{"speaker":"Clare Rusbridge","startTime":362.974,"endTime":367.127,"body":"daily. I don't need to tell you"},{"speaker":"Clare Rusbridge","startTime":367.196,"endTime":371.071,"body":"that that is an advantage."},{"speaker":"Clare Rusbridge","startTime":367.196,"endTime":371.071,"body":"Gabapentin is, I think you're"},{"speaker":"Clare Rusbridge","startTime":371.14,"endTime":375.085,"body":"probably all familiar with."},{"speaker":"Clare Rusbridge","startTime":371.14,"endTime":375.085,"body":"Pregabalin, I don't think you"},{"speaker":"Clare Rusbridge","startTime":375.154,"endTime":378.96,"body":"are necessarily quite as"},{"speaker":"Clare Rusbridge","startTime":375.154,"endTime":378.96,"body":"familiar with, it binds to the"},{"speaker":"Clare Rusbridge","startTime":379.03,"endTime":383.113,"body":"receptor for longer with more"},{"speaker":"Clare Rusbridge","startTime":379.03,"endTime":383.113,"body":"affinity. So it's a BID drug."},{"speaker":"Clare Rusbridge","startTime":383.182,"endTime":387.126,"body":"You get have a lower dose. And"},{"speaker":"Clare Rusbridge","startTime":383.182,"endTime":387.126,"body":"it's surprising, it can be"},{"speaker":"Clare Rusbridge","startTime":387.196,"endTime":390.933,"body":"extremely useful. And I will"},{"speaker":"Clare Rusbridge","startTime":387.196,"endTime":390.933,"body":"often maybe start them on"},{"speaker":"Clare Rusbridge","startTime":391.002,"endTime":394.946,"body":"Gabapentin. But switch to"},{"speaker":"Clare Rusbridge","startTime":391.002,"endTime":394.946,"body":"pregabalins, pregabalin you can"},{"speaker":"Clare Rusbridge","startTime":395.016,"endTime":398.476,"body":"get as a liquid. So I may"},{"speaker":"Clare Rusbridge","startTime":395.016,"endTime":398.476,"body":"actually just start with"},{"speaker":"Clare Rusbridge","startTime":398.545,"endTime":400.76,"body":"pregabalin as as an easier drug."},{"speaker":"Nathalie Dowgray","startTime":401.47,"endTime":403.51,"body":"And now I'm"},{"speaker":"Nathalie Dowgray","startTime":401.47,"endTime":403.51,"body":"going to be talking to Dr. Alix"},{"speaker":"Nathalie Dowgray","startTime":403.51,"endTime":407.38,"body":"Freeman about her JFMS clinical"},{"speaker":"Nathalie Dowgray","startTime":403.51,"endTime":407.38,"body":"spotlight article on mandibular"},{"speaker":"Nathalie Dowgray","startTime":407.38,"endTime":410.83,"body":"fracture repair techniques in"},{"speaker":"Nathalie Dowgray","startTime":407.38,"endTime":410.83,"body":"cats, a dentist perspective."},{"speaker":"Nathalie Dowgray","startTime":411.91,"endTime":415.87,"body":"What would be your top tips for"},{"speaker":"Nathalie Dowgray","startTime":411.91,"endTime":415.87,"body":"us in GP practice with these"},{"speaker":"Nathalie Dowgray","startTime":415.87,"endTime":419.35,"body":"cases, when they present to us,"},{"speaker":"Nathalie Dowgray","startTime":415.87,"endTime":419.35,"body":"to really start that diagnostic"},{"speaker":"Nathalie Dowgray","startTime":419.35,"endTime":422.44,"body":"workup? What kind of things do"},{"speaker":"Nathalie Dowgray","startTime":419.35,"endTime":422.44,"body":"you like to see when they get"},{"speaker":"Nathalie Dowgray","startTime":422.44,"endTime":423.46,"body":"referred to you?"},{"speaker":"Alix Freeman","startTime":424.65,"endTime":427.11,"body":"I guess from a"},{"speaker":"Alix Freeman","startTime":424.65,"endTime":427.11,"body":"head trauma point of view, I"},{"speaker":"Alix Freeman","startTime":427.11,"endTime":431.01,"body":"think yes, having stabilised the"},{"speaker":"Alix Freeman","startTime":427.11,"endTime":431.01,"body":"patient. I think that there's a"},{"speaker":"Alix Freeman","startTime":431.01,"endTime":433.53,"body":"lot that you can do in the"},{"speaker":"Alix Freeman","startTime":431.01,"endTime":433.53,"body":"initial assessment where you"},{"speaker":"Alix Freeman","startTime":433.62,"endTime":437.16,"body":"also might, for example, take"},{"speaker":"Alix Freeman","startTime":433.62,"endTime":437.16,"body":"your other diagnostic"},{"speaker":"Alix Freeman","startTime":437.16,"endTime":441.24,"body":"investigations like your chest"},{"speaker":"Alix Freeman","startTime":437.16,"endTime":441.24,"body":"or abdomen radiographs, or point"},{"speaker":"Alix Freeman","startTime":441.24,"endTime":445.29,"body":"of care ultrasound, it's really"},{"speaker":"Alix Freeman","startTime":441.24,"endTime":445.29,"body":"important to just do your basic"},{"speaker":"Alix Freeman","startTime":445.29,"endTime":449.43,"body":"assessments, like do a detailed"},{"speaker":"Alix Freeman","startTime":445.29,"endTime":449.43,"body":"oral examination, get your"},{"speaker":"Alix Freeman","startTime":449.7,"endTime":453.12,"body":"periodontal probe out, have a"},{"speaker":"Alix Freeman","startTime":449.7,"endTime":453.12,"body":"good poke and prod in the mouth."},{"speaker":"Alix Freeman","startTime":453.39,"endTime":456.93,"body":"Some people haven't even looked"},{"speaker":"Alix Freeman","startTime":453.39,"endTime":456.93,"body":"at the mouth when they refer"},{"speaker":"Alix Freeman","startTime":456.93,"endTime":459.24,"body":"these cases to us, which is"},{"speaker":"Alix Freeman","startTime":456.93,"endTime":459.24,"body":"totally fine because they're"},{"speaker":"Alix Freeman","startTime":459.24,"endTime":463.11,"body":"coming to see us but when"},{"speaker":"Alix Freeman","startTime":459.24,"endTime":463.11,"body":"looking after them in primary"},{"speaker":"Alix Freeman","startTime":463.11,"endTime":467.07,"body":"care practice, it's just really"},{"speaker":"Alix Freeman","startTime":463.11,"endTime":467.07,"body":"important not to overlook simple"},{"speaker":"Alix Freeman","startTime":467.07,"endTime":472.05,"body":"things like oral wounds or"},{"speaker":"Alix Freeman","startTime":467.07,"endTime":472.05,"body":"lacerations, fractured teeth,"},{"speaker":"Alix Freeman","startTime":472.5,"endTime":475.98,"body":"you know. I guess that's one of"},{"speaker":"Alix Freeman","startTime":472.5,"endTime":475.98,"body":"my big bugbears, that the enamel"},{"speaker":"Alix Freeman","startTime":475.98,"endTime":480.57,"body":"on cats teeth is very, very"},{"speaker":"Alix Freeman","startTime":475.98,"endTime":480.57,"body":"thin. So therefore, what might"},{"speaker":"Alix Freeman","startTime":480.57,"endTime":484.26,"body":"appear to be very small damage"},{"speaker":"Alix Freeman","startTime":480.57,"endTime":484.26,"body":"to the teeth can actually cause"},{"speaker":"Alix Freeman","startTime":484.26,"endTime":487.56,"body":"the patient an overwhelming"},{"speaker":"Alix Freeman","startTime":484.26,"endTime":487.56,"body":"amount of pain because that"},{"speaker":"Alix Freeman","startTime":487.56,"endTime":490.26,"body":"small amount of damage has"},{"speaker":"Alix Freeman","startTime":487.56,"endTime":490.26,"body":"caused a complicated crown"},{"speaker":"Alix Freeman","startTime":490.26,"endTime":495.12,"body":"fracture in an exposed pulp. So"},{"speaker":"Alix Freeman","startTime":490.26,"endTime":495.12,"body":"I think in practice, really my"},{"speaker":"Alix Freeman","startTime":495.15,"endTime":498.66,"body":"top tips are to do a good"},{"speaker":"Alix Freeman","startTime":495.15,"endTime":498.66,"body":"clinical examination,"},{"speaker":"Alix Freeman","startTime":499.44,"endTime":503.49,"body":"particularly checking for any"},{"speaker":"Alix Freeman","startTime":499.44,"endTime":503.49,"body":"damage that you might miss with"},{"speaker":"Alix Freeman","startTime":503.49,"endTime":507.27,"body":"a quick glance in the mouth. And"},{"speaker":"Alix Freeman","startTime":503.49,"endTime":507.27,"body":"then really closely assessing"},{"speaker":"Alix Freeman","startTime":507.27,"endTime":509.85,"body":"the occlusion because that's the"},{"speaker":"Alix Freeman","startTime":507.27,"endTime":509.85,"body":"thing that's primarily going to"},{"speaker":"Alix Freeman","startTime":509.85,"endTime":514.68,"body":"dictate how much treatment this"},{"speaker":"Alix Freeman","startTime":509.85,"endTime":514.68,"body":"patient needs for its head"},{"speaker":"Alix Freeman","startTime":514.68,"endTime":520.11,"body":"trauma. If the teeth are lined"},{"speaker":"Alix Freeman","startTime":514.68,"endTime":520.11,"body":"up well, so if you can check at"},{"speaker":"Alix Freeman","startTime":520.11,"endTime":523.29,"body":"the front and at the back both"},{"speaker":"Alix Freeman","startTime":520.11,"endTime":523.29,"body":"sides and there is a good"},{"speaker":"Alix Freeman","startTime":523.29,"endTime":527.04,"body":"occlusion, then actually most of"},{"speaker":"Alix Freeman","startTime":523.29,"endTime":527.04,"body":"those patients can be managed in"},{"speaker":"Alix Freeman","startTime":527.04,"endTime":531.63,"body":"a really conservative manner. If"},{"speaker":"Alix Freeman","startTime":527.04,"endTime":531.63,"body":"you've got a malocclusion, then"},{"speaker":"Alix Freeman","startTime":531.87,"endTime":534.57,"body":"at that point, you really need"},{"speaker":"Alix Freeman","startTime":531.87,"endTime":534.57,"body":"to think about what part of the"},{"speaker":"Alix Freeman","startTime":534.57,"endTime":538.98,"body":"face that's broken is causing"},{"speaker":"Alix Freeman","startTime":534.57,"endTime":538.98,"body":"that malocclusion and take it"},{"speaker":"Alix Freeman","startTime":538.98,"endTime":541.83,"body":"from there. But you can"},{"speaker":"Alix Freeman","startTime":538.98,"endTime":541.83,"body":"certainly go a long way with"},{"speaker":"Alix Freeman","startTime":541.83,"endTime":545.61,"body":"these patients by doing a"},{"speaker":"Alix Freeman","startTime":541.83,"endTime":545.61,"body":"detailed oral examination, and"},{"speaker":"Alix Freeman","startTime":545.61,"endTime":549.75,"body":"particularly closing any oral"},{"speaker":"Alix Freeman","startTime":545.61,"endTime":549.75,"body":"wounds as well. It's surprising"},{"speaker":"Alix Freeman","startTime":549.75,"endTime":554.64,"body":"how much stability can add to a"},{"speaker":"Alix Freeman","startTime":549.75,"endTime":554.64,"body":"patient that's got facial"},{"speaker":"Alix Freeman","startTime":554.64,"endTime":558.63,"body":"fractures, just closing your"},{"speaker":"Alix Freeman","startTime":554.64,"endTime":558.63,"body":"oral wound can help them out a"},{"speaker":"Nathalie Dowgray","startTime":558.0,"endTime":560.566,"body":"Thank you for"},{"speaker":"Nathalie Dowgray","startTime":558.0,"endTime":560.566,"body":"listening. If you're an ISFM"},{"speaker":"Nathalie Dowgray","startTime":558.63,"endTime":558.96,"body":"lot."},{"speaker":"Nathalie Dowgray","startTime":560.627,"endTime":564.049,"body":"member, you can hear more from"},{"speaker":"Nathalie Dowgray","startTime":560.627,"endTime":564.049,"body":"Dr. Freeman with her full"},{"speaker":"Nathalie Dowgray","startTime":564.11,"endTime":568.02,"body":"interview being available on the"},{"speaker":"Nathalie Dowgray","startTime":564.11,"endTime":568.02,"body":"ISFM members podcast. To access"},{"speaker":"Nathalie Dowgray","startTime":568.081,"endTime":571.076,"body":"this please visit"},{"speaker":"Nathalie Dowgray","startTime":568.081,"endTime":571.076,"body":"portal.icatcare.org. As well as"},{"speaker":"Nathalie Dowgray","startTime":571.137,"endTime":574.681,"body":"the podcast, you can also access"},{"speaker":"Nathalie Dowgray","startTime":571.137,"endTime":574.681,"body":"all the other ISFM member"},{"speaker":"Nathalie Dowgray","startTime":574.742,"endTime":578.347,"body":"benefits, including Professor"},{"speaker":"Nathalie Dowgray","startTime":574.742,"endTime":578.347,"body":"Rusbridge's lectures from our"},{"speaker":"Nathalie Dowgray","startTime":578.408,"endTime":582.074,"body":"ISFM Rhodes Congress, monthly"},{"speaker":"Nathalie Dowgray","startTime":578.408,"endTime":582.074,"body":"webinars, the discussion forum"},{"speaker":"Nathalie Dowgray","startTime":582.135,"endTime":585.862,"body":"and much much more. Don't forget"},{"speaker":"Nathalie Dowgray","startTime":582.135,"endTime":585.862,"body":"JFMS now also an open access"},{"speaker":"Nathalie Dowgray","startTime":585.924,"endTime":589.834,"body":"journal. So if you wish to read"},{"speaker":"Nathalie Dowgray","startTime":585.924,"endTime":589.834,"body":"Dr. Freeman's clinical spotlight"},{"speaker":"Nathalie Dowgray","startTime":589.895,"endTime":593.317,"body":"article, please do follow the"},{"speaker":"Nathalie Dowgray","startTime":589.895,"endTime":593.317,"body":"link in the show notes. If"},{"speaker":"Nathalie Dowgray","startTime":593.378,"endTime":596.983,"body":"you're looking for more CPD in"},{"speaker":"Nathalie Dowgray","startTime":593.378,"endTime":596.983,"body":"March we have an open access"},{"speaker":"Nathalie Dowgray","startTime":597.044,"endTime":600.466,"body":"webinar from Royal Canin,"},{"speaker":"Nathalie Dowgray","startTime":597.044,"endTime":600.466,"body":"Doctors Sam Taylor and Cecilia"},{"speaker":"Nathalie Dowgray","startTime":600.527,"endTime":604.01,"body":"Villaverde are going to be"},{"speaker":"Nathalie Dowgray","startTime":600.527,"endTime":604.01,"body":"speaking about inappetence and"},{"speaker":"Nathalie Dowgray","startTime":604.071,"endTime":607.676,"body":"feeding tubes in cats. And"},{"speaker":"Nathalie Dowgray","startTime":604.071,"endTime":607.676,"body":"that's going to be going live on"},{"speaker":"Nathalie Dowgray","startTime":607.737,"endTime":611.587,"body":"the 2nd of March. We'll be back"},{"speaker":"Nathalie Dowgray","startTime":607.737,"endTime":611.587,"body":"next month with more interviews"},{"speaker":"Nathalie Dowgray","startTime":611.648,"endTime":616.17,"body":"recorded at ISFM Rhodes and next"},{"speaker":"Nathalie Dowgray","startTime":611.648,"endTime":616.17,"body":"months JFMS clinical spotlight interview."}]}