Senior Feline Wellness Clinics: Is prevention better than cure?

Welcome to this bonus episode of Chattering with ISFM, brought to you in collaboration with IDEXX and Purina. In this episode, Nathalie Dowgray is in discussion with Dr. Zoe Belshaw about senior wellness clinics.

Our conversation goes beyond wondering if prevention is better than cure and expands into a discussion about best practices when setting up a wellness clinic, the importance of contextualised care and examines the relationship between the veterinarian, the caregivers and the cat itself. We hope you enjoy this episode!

For further reading material please visit:

https://www.catcare4life.org/

For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host:
Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK

Speakers:
Zoe Belshaw

Zoe is a veterinary surgeon with a clinical specialism in small animal internal medicine. She received a PhD from the University of Nottingham in 2017 for investigating welfare assessment in canine osteoarthritis, and was awarded the BSAVA Petsavers Award in 2020. She has worked in general practice, referral clinics, university teaching hospitals and charity practice. She is currently combining looking after a toddler with collaborative research on how veterinary professionals and owners make decisions about pets with chronic illness, how the quality of life of those pets and owners can best be assessed, and characterising the Pandemic Puppy phenomenon.

Creators & Guests

Host

Nathalie Dowgray

What is Chattering With ISFM?

Welcome to Chattering With ISFM, the official monthly podcast of the International Society of Feline Medicine, hosted by Nathalie Dowgray (Head of ISFM). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to ISFM members at portal.icatcare.org. If you would like access to our full episodes, would like to become an ISFM member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Nathalie Dowgray: Hello and
welcome to this bonus episode

of Chattering with ISFM.

Brought to you in collaboration
with IDEXX and Purina.

In this episode, I'm
in discussion with Dr.

Zoe Belshaw, and we're going to be
talking about senior wellness clinics.

Is prevention better than a cure?

But unsurprisingly on this topic,
we expanded into wellness clinics in

general, and also a discussion around
contextualised care, the interaction

that's really required between the
vet, the caregiver, and the cat itself.

We hope you enjoy the discussion.

What do you see as the benefits to senior
screening and wellness screening clinics?

Zoe Belshaw: Yeah, I think that's a
really great place to start because if

there's no benefits to it, then we're
not going to be wanting to do them.

I think the big ones are picking
up new problems before they can

negatively impact the cat, but
also monitoring existing problems.

It's also a really good opportunity to
talk to owners, to bond with our clients.

From personal experiences, having an
older pet can be really hard work.

It can feel quite isolating with problems
like cognitive dysfunction, which may

be disrupting owner's sleep and they
may quite not know what's going on.

So, there's lots of things where I
think we can really help support owners.

And really these are for owners
to discuss things with us as

much as us to screen the cat.

So supporting the owner and the cat
as a pair to kind of to age healthily

together and checking that the owner's
really got all the tools that they need

and your veterinary input to help spot
any problems that might be emerging

before they get to be too problematic.

Nathalie Dowgray: I think that's a
really interesting point about the

impact of aging pets on the owner.

You mentioned things like cognitive
dysfunction and many of us with older

pets know it's harder to do things
like go away for longer holidays when

you've got that concern of leaving a
pet on their own or having to organise

someone maybe with perhaps a little
bit more knowledge than what you'd

needed previously to look after it.

So that, that impact is really important.

Zoe Belshaw: Yeah, I think
that's a really big one.

Actually, I ran a series for a
while in the Veterinary Record

called What's Your Client Thinking?

And the very first one of those was
the owner of a cat with chronic kidney

disease, whose cat lived two and a half
years longer than she thought it would.

And at the beginning of this cat's
illness trajectory, she took on doing

all of these things, which she thought
this is going to be fine because it's

probably not going to sadly be for
very long and I don't mind doing it.

Two and a half years later, she was
still doing all these things and the

cat was having increasing problems.

And she found it really hard to go away
because it was such a big responsibility

for somebody else to look after the
cat, essentially to be making decisions

on her behalf when she was away.

And I think we really underestimate that
plus also the concern that owners have

as their pets, very much loved often,
pets age around making quality of life

decisions, around juggling different
medications, different health needs,

different priorities in a multi cat
household particularly can be really

challenging and trying to balance the
needs and diets of different cats.

So, I think there's lots and lots of
things that we can talk about in these

clinics, as well as just obviously
focusing on the physical exam.

Without the owner, we can't really
do anything to fix the cat, so

it's so important to have them on
board and to make sure that they're

as well supported as they can be.

And there's a really big role
for us in doing that, I think.

Nathalie Dowgray: I think that's,
that's really important to be

considering that emotional load
that you mentioned earlier as well.

They're all things that we really
need to be taking into consideration.

Zoe Belshaw: Absolutely.

There's no point having a gold standard,
kind of inverted commas, care package.

If it's something that the owner
and the cat just can't do, you

know, there's no point prescribing
medication a cat can't take.

There's no point setting up a series of
consultations for a client who can't get

the cat into a basket or who is really
worried about transporting their cat.

It's not going to happen.

So contextualised care
is so, so important.

Looking at the cat, the owner and
ourselves, what facilities we've got,

what knowledge we have, what we can
realistically provide and tailoring

the care and not feeling that we
need to be beholden to a specific set

of guidance that somebody else has
written that might just not be right.

For, for us and for the pets in
front of us, really important.

Nathalie Dowgray: Some of the stuff
we're talking about today is based on

very much guidance and guidelines, but
that contextualisation piece I think is

always really important and I think as
vets, maybe we sometimes get slightly

hung up on that, what we should be doing,
what's the best thing we should be doing

in terms of that physical health, but
the cat compliance and the owner buy

in compliance, and ability to perform
some of these things are equally as

important and I think it's a balancing
act between all those three factors

and that's going to achieve the best
outcome for the individual patient.

So, I guess when we then
start to think about senior

clinics and wellness programs.

What sort of ages do you think we
should be starting to maybe increase

the frequency of appointments or start
to maybe expand on what we're doing

within those regular wellness checks?

Zoe Belshaw: You need to know who
you're going to include in these for

when you're going to be advertising
and educating your team about it.

And advice does vary quite widely
as to when to start, and it may be

dependent on your cat population.

We know from surveys like the PDSA's
pet Paw Survey that the number of cats

presenting for routine consultations,
such as boosters really drops off.

So even just getting them through
the door once a year is a great

start, but International Cat Care
define a mature cat as being about

7 to 10, a senior cat as 11 to 14.

And what used to be geriatric has
now been rebranded, which I think

is fantastic, as a super senior as
15 plus, and you can pick one of

those time points very commonly.

We know that mature cats do start
to show these problems from 7 plus,

so many clinics will initiate checks
then, some will wait until they're 10.

So potentially starting a check on an
annual basis from 7 and then starting to

move into potentially annual up to twice
a year checks in that senior 11 to 14

bracket, if you've got the right cat, the
right owner and the right circumstances,

even going up to three to four times a
year in those super seniors, very much

again, tailoring it on what the owner
and the cat feel is right for them.

And also what problems you've got.

The more you screen them, the more you
find, certainly I know from your work

at Liverpool, what age do you enrol
cats from in the Liverpool program?

Nathalie Dowgray: Between 7 and 10.

And we're now coming into our
seventh year of data collection.

So, the hope that the next stage of
analysis and the work will be starting

to refine a little bit more about
what test and when, and it was really

interesting when you said the more you
look for things, the more you find,

and within that cohort, part of what we
were doing was including an orthopaedic

assessment at each appointment as well.

And whilst we weren't doing x-rays,
we couldn't say definitively that

these cats have osteoarthritis
or degenerative joint disease.

We were starting to see a really
high number of them, over 50%,

we're just showing changes on their
orthopaedic assessment that may have

indicated we need to be starting to
think about osteoarthritis in cats.

When we think about intensity
of our appointments and what

we should be doing test wise.

If we start to be thinking about cats
from sort of seven years of age, we

found an awful lot of dental disease
and potentially indications that

their musculoskeletal system may be
starting to experience some pain.

And we may need to be looking at
interventions on that as well.

So, they were really common.

But those are things that
we don't necessarily need to

do additional testing for.

We need to be making sure that we're
doing a really good thorough examination.

So, I definitely agree with you
that getting cats back into the

vet clinic is really important.

Zoe Belshaw: Yeah.

So, I think probably just even starting to
emphasise, we'd like to see your cat once

a year between the ages, even of 7 and
10, even just if it's for a history take,

a full clinical exam, a body condition
score, a weight check, a muscle condition

score, and a general chat without
necessarily even needing to do any extra

stuff at that point in time if there's
no indication of any additional problems.

But again, tailoring that for different
owners, but then when they move into

that more senior bracket, thinking about
potentially building in more tests.

So, very much rather than it
being a one size fits all.

And again, that might help
people financially as well.

There are advantages to seeing those
cats, even just getting through the

door to do what seems to us like the
basics may be incredibly valuable

for both the cat and the client.

Nathalie Dowgray: That's I think a really
important message that hopefully we'll

reinforce during this podcast, because
definitely when we found when we were

enrolling for that ageing cohort, a lot
of the cats from the population that we

were recruiting from had been neutered
and had kitten vaccines, and then they

may have had one or two appointments
where they'd been, a trauma incident

or a cat bite abscess, but a large
proportion of them weren't coming in for

regular wellness checks, for boosters.

So, and the other thing that I found quite
interesting with it, we're perhaps seeing

lower prevalence of some of the diseases
that we thought we would be seeing in

higher prevalence at this age range.

And whilst we wouldn't consider ourselves
an interventional study, just the fact

that we've been providing free wellness
checks on a biannual basis for some

of these cats now the last six years.

That in itself actually might
have been an intervention.

So, I think there's to me, potentially
some benefits that we need to explore a

little bit more and maybe get some more
data on just getting cats through the

door for a good, thorough examinations.

I'll hopefully have some more interesting
stuff to report on that in the future, but

I'm definitely thinking at least at this
point, there's just a benefit in that.

Zoe Belshaw: Absolutely.

I'm sure there is.

I think any education is intervention
and getting owners to just even be

aware of what things you're looking
for, what things to look out for.

I would personally call
that an intervention.

So, I'm not particularly surprised
because the more switched on

owners are to look at things.

Repeatedly in my PhD, I had owners
saying like, when we go to a vet for an

annual visit, what we'd really like is
to be told what to look out for next.

We don't necessarily want a review of
what's going on and, oh, fantastic, isn't

he doing well or everything's stable.

We want to be told what's coming next.

What do we need to look out for?

And that's exactly what it sounds like
you've done with your healthy aging clinic

is to provide owners with that information
about this is what we're looking for, this

is what might come next at the next stage.

If you see these things,
this is what they might be.

And this is what we need to do.

We need to have as a thing, that's
really going to proceed almost launching

these clinics in a practice is really
raising the awareness and educating

our owners about the fact that there
are many things that are thought to be

just old age, and actually they're not.

And it's not about us making money by
trying to do tests and sell product.

It's about really these things actually
being things that the cats can be helped

with if we diagnose them and can help them
to live longer, healthier, happier lives.

And that that will have less of
an impact on your life as well if

they're managing their conditions.

Nathalie Dowgray: I think on our side, the
reason why I didn't really think it was

an intervention is because we were just
asking questionnaire questions every year.

But those were the questions.

Have you seen this?

Have you seen that?

So naturally people were thinking, okay,
this is something I need to look out for.

What is an interesting thing, and
then this is probably, I guess I would

argue a little bit more apparent with
cats than dogs is they are potentially

quite good at hiding sides of disease.

And so, there are some things that, until
stuff gets quite bad, we won't necessarily

know that this is starting to go on.

Hypertension is probably a good example of
that, target organ damage, acute blindness

is often sometimes that first sign.

So, when we start to think about what
diagnostic tests we should include

and when, what sort of recommendations
would you be considering for those?

Zoe Belshaw: Yeah, I think, as you said,
there's lots of problems that cats are

pretty good at hiding, aren't they?

Hypertension being an excellent one that
unless they get retinal detachment or

some other sort of secondary problem
associated with that, then it is pretty

difficult for owners to spot these things.

And similarly with some of the PUPD
type problems, I really like Sarah

Caney's advice that every older cat
should have a litter tray in the house.

Just so the owners can have a bit of
an idea as to what a urine output is

like, because many of these outdoor
peeing cats, the owners may just have

no idea what their thirst and their,
and their urination is actually like.

The diagnostic tests need to
be informed by what potential

problems these cats might have.

And the big ones that we're going to
commonly think about, I think, in older

cats are going to be a hyperthyroidism,
chronic kidney disease, hypertension,

diabetes mellitus, which we know will
increase in prevalence with age and

owners are probably more likely to
recognise them too, because they're

going to be associated with probably
clinical signs of thirst, urination,

vocalisation, potentially weight changes.

ISFM, International Cat Care have
done some great work increasing

our awareness of like looking at
how they go up and down stairs and

ability to jump and things like that.

So that's another one on our radar.

We've also got problems that we might
not have thought about quite so much

around cardiac disease, overweight
and obesity, long claws, dental

disease, deafness, constipation.

So, when we're thinking about all of these
things that might be going on, as ever,

the really key diagnostic tests are going
to be really a history, a clinical exam.

I think those are the big things
that we must make sure we always do.

Similarly, doing a weight check,
a body condition score, ideally

a muscle condition score and the
website Cat Care For Life's got

some really nice information about
what we can think about doing.

But obviously then, depending on
what we might find on a clinical

exam, plus or minus, if we want to
get into doing routine screening.

We can think about including
cystocentesis to check our urine

specific gravity and our dipstick.

If you can cysto a cat competently
and confidently, then that's a

really handy thing to be able to do.

And equally haematology and biochemistry
can certainly have their place.

Certainly, absolutely, if they're guided
by clinical examination, but also as a

routine screening tool, we can use those
to pick up these early signs of chronic

kidney disease and other end organ damage
that we might get from hypertension.

There's a bolt on again, then if you've
got a compliant cat, if you're confident,

competent, you've got the right setting.

Thinking about oscillometric blood
pressure measurement too can be a

really good adjunct to something
else that we can think of doing.

And similarly, ophthalmoscopy
to just check those retina and

see what can be going on there.

So, I think there's a whole gamut
of different tests we can perform,

whether we should perform every
test on every cat in every clinic.

I think probably we shouldn't, but I think
we should always do the history taking.

We should always do the clinical
exam and we should always ask those

open questions of owners saying, is
there anything you're worried about?

Is there anything that
you think's changed?

Is there any questions that you've got?

Is there anything that you think you'd
like to know about between the period

of this examination and the next one?

Because it's those kinds of pauses and
those open questions that actually may

point to some of the big things that you
might not necessarily pick up in your

history or clinical exam, or that might be
something that's a really tiny thing, but

it's a really big problem for the owner.

And that might be the, yeah, my cat
can't get out the cat flap anymore.

It started yowling at two in the morning
and it's waking me up and it's making it

dangerous for me to drive to work because.

I'm really struggling.

We can use a questionnaires as,
as you said, you do at Liverpool.

So it's a mix of, yeah, history,
clinical exam, and then those adjunct

haematology, biochemistry, cysto, blood
pressure, and, and ophthalmoscopy.

Plus, I imagine if you want to do
ortho exams, if you've got indications

for that, whether that's physical
exam again, or whether it's having a

place that a cat can run around and
climb and really just observing them

in your consulting room, seeing what
they're up to, checking the coat.

All of those bits and bobs.

Nathalie Dowgray: Yeah, I think that's
often the take home message from this.

You can get a lot from cats if you're
able to do a good thorough physical exam.

And I'll just do a quick plug
for the Cat Friendly Clinic

Scheme on that one as well.

Because the happier the cat is in
the vet clinic, the easier it is to

do a full clinical exam on them too.

Zoe Belshaw: Absolutely.

A useful one to consider.

And I think something that's really
good advice was to make sure that

owners are really confident in how
to transport a cat to the clinic.

And that again is, is something
that we can all do, but owners may

be really worried about how to get
the cat in the carrier, how to get

the carrier in the car, whether
the cat's going to soil itself.

Cause if you've got a cat that's arrived,
stressed out, covered in poo that

you can't get out of the box, you can
still do a really good history take.

You can still observe the cat.

You can still potentially weigh the
cat, but you're going to be pretty

limited in what else you can do.

And it may be that having had that
experience once, the owner is going to

say, do you know what, I am absolutely
not going to opt into doing this four

times a year, like that's not me.

Making sure before you start that they've
got all of that information, that they're

confident about getting the cat to you.

And as you say, absolutely having
the right waiting room set up and

thinking about all of those things
that cats need to make them calm in

a clinical setting is so important.

And anybody booking these needs to be
getting leaflets, information, and just

even a phone call to just check that
they're happy to get the cat to you.

And to give advice, it can
start when these are kittens.

Having done that early on, you'll
then much more easily be able to get

these cats keeping coming back to you
because they'll be happy to travel.

Nathalie Dowgray: That's
a really important point.

Every cat's an individual.

One of the barriers we found, even with
offering a free service, sometimes there's

a fear that we're going to find something.

And so there's the piece to discuss around
how we can be communicating our findings,

whether we haven't found anything or
we have found something and how we

can maybe allay some of those fears.

Zoe Belshaw: Yeah, definitely.

I think that's a really big
one, that some owners may avoid

presenting their pet to the clinic.

Certainly, when I was working in the
PDSA, that was a relatively common thing

that, unfortunately, we'd get animals
presented with very late stage disease

because other owners had learned from
their neighbours that they took their pet

to the vets and their pet was euthanized.

And that kind of led to a
self-perpetuating thing in certain

small communities where these animals
were only being presented with

such late stage disease that there
really was nothing that we could do.

And it was really hard to
break that cycle because it did

positively reinforce itself.

That if you wait until you've
got a large ulcerated mass, then

unfortunately it may be really hard
for us to be able to do anything.

And so I think owners are going to
be worried about finding something,

but I think emphasising the fact that
we've getting better and better at

feline medicine now, and there are
more and more solutions, cats can live

happily and healthily with a lot of
these diseases, whether it's chronic

kidney disease, whether it's diabetes
mellitus, whether it's hypertension,

we've got treatments for these things.

So I think emphasising that these things
are really common and that the majority

of cats will have something and that there
is something that you can do and that

there are multiple different solutions.

For many of these different problems,
there'll be different formulations of

medication, there'll be different ways
of managing problems, potentially,

I think is really important.

As we age, we almost always get
something, but it doesn't necessarily

mean that it's going to be a serious
thing, or if it is a serious thing, then

much better for us to find it sooner
and be able to do something about it.

And equally, if we don't find anything,
then we can absolutely celebrate success.

And yes, there can be some owner
framing of the fact that I've spent

all this money and now you didn't find
anything and it was a waste of money.

And I think we can tend probably
to worry more about that

actually than our owners do.

You can be really delighted actually
for the owner and the cat that, that

you didn't find anything and that
they've got a clean bill of health.

I would hope that owners would be really
happy about it, but it's also again,

really important that you are taking
the time to educate and inform owners.

So even if you haven't found anything
on clinical exam, making sure you've

taken that time to be able to answer
any questions they have, discuss any

concerns and provide them with free
advice or make it feel that your advice

is something that they've paid for.

Nathalie Dowgray: There's a lot of
advice, especially around things like

dietary changes, cats are getting
older or how we can be modifying the

home environment, especially when we
consider how prevalent um, osteoarthritis

is in cats as they get older.

And even if they're not at the stage that
we feel that an intervention like a non

steroidal or another type of analgesia is
required, there's a lot we can do in terms

of advice around maybe dietary changes or
home environmental modification as well.

And I think that communication
piece is, is really useful.

I always find the dietary one quite
interesting because again, there

can be this perception that we're
trying to sell them something.

How do you fit dietary advice
into your consultations?

Zoe Belshaw: Yeah, I think it's
really tricky and cats can be so fussy

and owners can be so delighted that
they finally found something that

cats will consistently eat, that I'm
cautious to chuck that all away and

replace it with a bag of something
that's got the word veterinary on it.

But certainly adding, increasing
moisture content can be a really good

idea, whether that's adding just a
little bit of extra water to cat food.

That can be one of the most useful
things I think that we can do in these

senior cats to reduce the risk of
constipation and keep that water going.

And really important again, with any
of these things, look at the snacks

that these animals are getting,
because there's no point spending a

fortune on a specific bag of veterinary
food where the cat's having 25

packets of Dreamies a day, you know?

So it's getting that balance right.

And again, thinking about whether
that really is the best thing

for the animal and then what the
client wants, what they can manage.

How many other cats
there are in the house?

Are you going to be feeding 25 cats on a
renal diet if it's a multi cat household?

So, it's really a case of
talking to the owner and really

thinking through the day and how
practically they're going to manage.

So many of these cats, that we
haven't really covered yet, are

multimorbid, they've got loads of
different problems going on at once.

So you might be trying to trade off your
hyperthyroidism, your osteoarthritis,

your early stage chronic kidney
disease, plus or minus diabetes

mellitus, they might be constipated
and they might be a mainly outdoor

cat that's a really hard to medicate.

And a lot of the time, with these
animals, we are having to just try to

juggle all of these different conditions
that may on paper require really

contrasting, conflicting management plans.

And it's really important to keep
stepping back and seeing this cat

as a whole rather than a series of
semi-broken, semi-functional body

parts and think, well, what's going to
work for this individual cat exactly?

What's going to work for this household?

Which is the most important of
these diseases for me to focus on.

And actually, that might mean I've got
to drop the ball a bit on this one, but

this is the one at the moment that's
currently impacting this cat's quality

of life more and is likely to impact
this cat's quality of life in the future.

And it may be, you may be managing one
really well for a while and letting

another one slide a little bit and
then picking up that other one as

the significance for that individual
cat becomes more substantial.

So, yeah, it is really tricky.

And the fact that we've now got diets
that are a bit more blended is so

helpful rather than it being, you
hypothetically need to get out six

different packets for the same cat because
it's got all the different conditions.

So yeah, definitely that's,
that's a big improvement.

Nathalie Dowgray: Yeah.

And I think what is the piece that's
having the most significant impact on

the cat's health and quality of life?

And focusing on that is really important.

We all attend quite a lot of CPD.

And I think one of the more engaging
ones I went to once was a series of,

of cases with cats with comorbidities
and trying to work out what was

the best diet to put them on.

And it really made your brain work.

Cause they were like, Oh, I
would have done that reflexively.

But actually they're right.

This is the one that probably
needs the more dietary focus on.

So, I think that piece
is really interesting.

And as part of my PhD work, I attended
a few human ageing research conferences.

And one of the things that I found really
interesting, one of those was where

they were talking about this decreased
thirst signalling in older people.

And we see all the warnings every
time Britain has a heat wave,

especially focusing on older people
to make sure that they are drinking

properly because dehydration
becomes a big complicating factor.

And when we think about cats, you
mentioned constipation earlier on as an

issue that we see, and there's that pain
related element with osteoarthritis that

may cause them to hold on a little bit.

But also, there's the fluid loss with
chronic kidney disease and the fact

that they're probably not drinking
as much as what they should do.

And so, I don't think I'm aware of
anything that proves that cats have that.

My suspicion is that they probably do.

Zoe Belshaw: Yeah, it's
really interesting.

And it's something that we all probably
need to just be more and more mindful

of with climate change really, we're
getting these, these hot spells

and we see the advice for elderly
people to drink more and stay cool.

We're good at telling owners of dogs,
not to walk them in the heat, but yeah,

thinking about proactively advising
owners of senior cats to up their water

intake during these hot spells, especially
if there are cats that prefer to drink

water sources from outside that will
potentially evaporate a lot more quickly.

So that's probably another
piece that maybe we're not

doing quite enough with there.

Nathalie Dowgray: I think people are
always a little bit surprised when I say

I'm a big fan of feeding cats a mixed
wet and dry diet, but that was always

part of my reasoning that actually that
water intake piece as they get older

is a really useful one to consider.

And I think you are right.

It's definitely a part of
the world that we're going to

have to be more proactive in.

If let's say people listening to the
podcast to become inspired and they want

to start maybe doing a bit more senior
testing or getting a senior clinic going

in their clinic, what sort of tips and
advice would you give them to do that?

Zoe Belshaw: I think it's really
important to have a load of foundations

before you even start by opening
your door, which we've already

discussed potential age bands.

You need to think about
who is going to run them.

The challenge, certainly in the United
Kingdom, that veterinary nurses are

not allowed to make a formal diagnosis.

And so, whilst it's fantastic to
have nurses running ageing clinics

because nurses really well trained
in these things, they can be great

communicators, owners can be much less
concerned potentially about raising

issues with nurses than they would be
about vets because they may feel that

the nurse can't, you know, rush them
into doing something quite so much.

But equally, it can lead to
challenges where a nurse needs to

make a diagnosis or finds an abdomen
mass or see something that they're

concerned about and then needs to
get a vet to come and sign it off.

When we're talking about osteoarthritic
cats, for example, many of these

cats, the owners report that they're
stiff or they might be stiff and

you can't necessarily diagnose
osteoarthritis as a veterinary nurse,

but you certainly can diagnose stiff.

Therefore, here's all of the
environmental modifications we could do.

But I think that's a really
big one to think about.

If you've got nurses who are running
the clinics, what are they going

to do if they find a problem?

Have you got enough nurses
consistently available who are going

to be happy to be client facing?

And then if it's going to
be vets doing it, then is it

going to be separate clinics?

Is it going to be something that's just
available as and when an owner wants it?

Or are you going to say, you know, open
the doors at half past two on a Tuesday

and say, that's my senior cat hour,
because I think there's pros and cons.

It's really important for your
clinic to work out exactly

how they're going to work.

Because the worst thing to do is have
vets that don't know when to recommend it.

Have receptionists that don't know when
to recommend them, have clients turning

up and then there not be the right person
available or the right kit available.

So, practice meeting, who's going to run
them, who's going to be included, what

tests are going to be included, what's
going to happen if you find a problem.

Have you got a protocol for
whether it's a vet or a nurse?

What's the next step for
each of those things?

Potentially thinking about developing
a questionnaire, sent that in advance

by email before they come in, or that
the nurse or the vet uses that as a

standardised tool, so that we're always
checking over the same things again.

Make sure you've got the right
leaflets in place to give advice.

Some clinics are including these
in, sort of, pet health clubs,

so that's pseudo free of charge.

You pay your monthly subscription.

And then when the pet hits senior,
the price goes up a little bit,

but these clinics are effectively
free because you're, you're paying

that just monthly subscription
versus others will charge for that.

And you've got to think about whether
you're going to discount the charging

for a package of tests versus how much
those individual tests would cost were

you to just come straight through the
vet for a non-health screening and be

very transparent about what's included,
what's not, how much it's going to

cost and be really clear as to what the
pathways are going to be for next steps.

Walk yourself through this
before you start setting up.

It's really easy to have one
enthusiastic staff member who says,

yeah, I'm going to take it on.

And for a senior vet to
be like, yeah, brilliant.

Off you go, run with it.

You take ownership of this fantastic
,and that poor person then can be left

standing in a consulting room with
nobody booked to come in because the

communications to the rest of the practice
haven't been there to support them.

Or that person goes on
mat leave or leaves.

And then what had been a really
successful clinic falls apart because

nobody else wanted to take it on board.

So I think, yeah, everybody in the
whole practice needs to be on board.

You need to educate everybody from
reception through to the most senior vet

as to, to what's included, to signpost
these things and be really confident

that everybody is on board with what
isn't included, how they run, so that

you're getting a consistent approach
every time these clients come in.

So, sorry, that was a quite a long
thing and it makes it sound a bit

daunting and hard, but it shouldn't be.

But there are so many, unfortunately,
of these types of clinics that

don't succeed or that reach a block
in the road where people think, Oh

yeah, we've got it all ready to go.

And, and then nobody comes.

It's so, so important to have that
foundation and to be advertising them

in the right way through Facebook,
through the reception desk and through

the vets in the consulting rooms.

Really selling it with the right language
that it's not just about testing.

It's not just about screening.

It's that opportunity
to come and have a chat.

We'll teach you about what to look for.

We can help you with any
problems that you've got.

Potentially even thinking about
setting up a senior cat club so that

owners can talk to each other and
share problems, their advice and tips.

And even thinking about having a once
a month tea club or something like

that, where people leave their cats at
home and just come in and have a chat

and share tips about how to manage a
diabetic cat or what it's like to live

with a cat with cognitive dysfunction
and allowing owners to feel like they're

part of something bigger than themselves.

Nathalie Dowgray: I think that's,
your point around that agreement

and consistency and all of that is a
huge part of the momentum, isn't it?

Owners get frustrated if they're
getting a different message every

time they're coming through.

So I think consistency is important.

And I think it is important to consider
all of those other complicating factors,

because currently, we're in an environment
where we're short on clinical staff, and

that momentum, that ability to be able to
keep things running is really important.

I think you raised a really nice
point at the end there around that

sort of peer support as well, and we
know that senior cats, they have a

massive benefit to their owners as
well, that sort of human animal bond.

If the pets are ageing well and they're
invested in their pet's health, that

also helps their own health as well.

And I think we can agree that
mental health support of having

a pet is really positive.

There's also potentially
sometimes a mental health

concern when your pet's unwell.

So, the more we can do to support
their healthy pet, I think the

better it is for their owner as well.

Zoe Belshaw: Yeah, I completely agree.

It's certainly that mental health
downside for some of these owners of

older pets, where they're worried about
what might happen, especially elderly

owners who are worried about how they're
going to cope with giving that care.

As cats are living longer and longer,
elderly people may have acquired cats

relatively late in their own age and may
be quite concerned about how they're going

to happen if they need to go into hospital
and providing support and information

about options available, whether
that's The Cinnamon Trust in the UK.

Whether you've got peripatetic
nurses, you could go and help

visits at home, that kind of thing.

All of those things are so important.

I think can, can really lead to a mental
health burden actually for owners of

elderly pets, the owner of the older
pet can increasingly get, get quite

worried and upset if they don't feel
they're being supported, or they haven't

got the information that they need.

They're not quite sure what
the plan's going to be next.

They're worried about what the vet or the
nurse might say the next time they go in.

They're worried that they might say
that's the end or they're worried

they're going to get pushed into doing
a test they can't afford or worried

they're going to get given medication
they just can't dispense, yeah.

All of those things that are super duper
important to cover and to allay fears

about teaching owners about how to pill
cats if they've not done it before,

giving them links to really helpful
websites can all just be such tiny

things that make these clinics a success.

Rather than a, I'll come once
then I'm not coming back.

Nathalie Dowgray: We have to reframe
some of this when we think about the

current economic climate as well.

Everyone's in a situation
where their money isn't going

as far as what it used to.

So, what would be your sort of final
thoughts on how we can convince clients

that this is a worthwhile investment
of both their time and their money?

Zoe Belshaw: Yeah, I think it's hard.

And I wonder if increasingly we do need to
do a tiered approach where you potentially

even just offer the history clinical
exam, weight check as a one level.

And then, have the option to do the
other things, albeit that it's not ideal.

It would be better, you know, it's
this idea of gold standard versus

contextualised care again, if the
only clinic that you offer is all

the bells and whistles that it's got
to be cystocentesis, oscillometric

blood pressure, blood tests.

And then it's like, well, I know
they can't get that out of my cat.

So, I can't access that clinic.

Or actually what I'd really like to be
able to do is to go in and have a chat

because I'm worried about something,
but, now I can't go because they've said

he's got to have all this stuff done
and I know that's not going to suit me.

So, um, thinking about tailoring that,
which again can help to tailor costs.

But I think it really is that idea that
if we catch something early, then it may

well be less expensive in the long run.

But I think the big thing is really
demonstrating what the value is going to

be, what's going to be included and really
making sure that what you say is going to

happen is going to happen in terms of that
verbal support, that time to listen and

having the right person in the room, who's
going to be knowledgeable enough to answer

the questions, I think is what's going
to make this a success or not really.

Nathalie Dowgray: Yeah, I have
to say I'd completely agree.

I think we can set up a structure,
but we need to be flexible within

that structure based on the individual
client needs, the cat's compliance,

and also our findings as well.

I think because I originally had
a shelter medicine background, my

thoughts on diagnostic tests are
always, is this test going to change

anything that I'm going to do?

And if the answer is yes, then
that's a test I want to run.

If the answer's no, that test would be
a nice to have, and for my information,

a nice to know, but it's not essential.

Zoe Belshaw: If it's not going to
change what you do, then don't do it.

I think there's an increasing concern
in the profession about people not doing

gold standard care within ourselves, about
being negligent, about missing things.

But actually, if that's informed consent
with the client and you and the client

have looked at what they can practically
do with this individual patient, I think

it's absolutely right to contextualise
that care and say, did you know what?

Yes, the idea would be to do that, but
at the moment that's not the appropriate

thing to do for this patient and this
owner and to make peace with that, we

can't always do what we might consider
to be the best thing and what we consider

to be the best thing might well not be
the best thing actually for that kind

of owner pet dyad, so I think we need
to be much more at peace with that

than we, than we perhaps currently are.

Less is definitely more in, in some
instances, but the history, the clinical

exam, the, what are you worried about?

The, what can I do to help is probably
more valuable than any diagnostic

test as at least as a basics.

Nathalie Dowgray: Definitely.

Thank you so much Zoe for your time.

Zoe Belshaw: My pleasure.

Nathalie Dowgray: Thanks for
listening everyone and thank you

IDEXX and Purina for supporting the
production of this bonus episode.

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