1 00:00:05,510 --> 00:00:07,950 Nathalie Dowgray: Hello and welcome to this bonus episode 2 00:00:07,980 --> 00:00:09,060 of Chattering with ISFM. 3 00:00:09,840 --> 00:00:12,870 Brought to you in collaboration with IDEXX and Purina. 4 00:00:13,250 --> 00:00:15,459 In this episode, I'm in discussion with Dr. 5 00:00:15,459 --> 00:00:18,979 Zoe Belshaw, and we're going to be talking about senior wellness clinics. 6 00:00:19,270 --> 00:00:21,009 Is prevention better than a cure? 7 00:00:21,530 --> 00:00:25,299 But unsurprisingly on this topic, we expanded into wellness clinics in 8 00:00:25,299 --> 00:00:29,459 general, and also a discussion around contextualised care, the interaction 9 00:00:29,460 --> 00:00:32,849 that's really required between the vet, the caregiver, and the cat itself. 10 00:00:33,519 --> 00:00:34,980 We hope you enjoy the discussion. 11 00:00:38,570 --> 00:00:43,099 What do you see as the benefits to senior screening and wellness screening clinics? 12 00:00:43,720 --> 00:00:45,879 Zoe Belshaw: Yeah, I think that's a really great place to start because if 13 00:00:45,879 --> 00:00:48,269 there's no benefits to it, then we're not going to be wanting to do them. 14 00:00:48,309 --> 00:00:50,830 I think the big ones are picking up new problems before they can 15 00:00:50,830 --> 00:00:54,490 negatively impact the cat, but also monitoring existing problems. 16 00:00:54,610 --> 00:00:59,060 It's also a really good opportunity to talk to owners, to bond with our clients. 17 00:00:59,069 --> 00:01:03,000 From personal experiences, having an older pet can be really hard work. 18 00:01:03,010 --> 00:01:06,559 It can feel quite isolating with problems like cognitive dysfunction, which may 19 00:01:06,559 --> 00:01:10,119 be disrupting owner's sleep and they may quite not know what's going on. 20 00:01:10,179 --> 00:01:13,554 So, there's lots of things where I think we can really help support owners. 21 00:01:13,925 --> 00:01:16,744 And really these are for owners to discuss things with us as 22 00:01:16,744 --> 00:01:18,124 much as us to screen the cat. 23 00:01:18,175 --> 00:01:23,714 So supporting the owner and the cat as a pair to kind of to age healthily 24 00:01:23,714 --> 00:01:26,734 together and checking that the owner's really got all the tools that they need 25 00:01:27,004 --> 00:01:30,124 and your veterinary input to help spot any problems that might be emerging 26 00:01:30,124 --> 00:01:31,884 before they get to be too problematic. 27 00:01:32,675 --> 00:01:34,535 Nathalie Dowgray: I think that's a really interesting point about the 28 00:01:34,535 --> 00:01:36,795 impact of aging pets on the owner. 29 00:01:36,805 --> 00:01:40,405 You mentioned things like cognitive dysfunction and many of us with older 30 00:01:40,485 --> 00:01:43,935 pets know it's harder to do things like go away for longer holidays when 31 00:01:43,935 --> 00:01:47,744 you've got that concern of leaving a pet on their own or having to organise 32 00:01:47,744 --> 00:01:50,424 someone maybe with perhaps a little bit more knowledge than what you'd 33 00:01:50,425 --> 00:01:52,294 needed previously to look after it. 34 00:01:52,454 --> 00:01:55,645 So that, that impact is really important. 35 00:01:55,710 --> 00:01:57,149 Zoe Belshaw: Yeah, I think that's a really big one. 36 00:01:57,270 --> 00:02:00,250 Actually, I ran a series for a while in the Veterinary Record 37 00:02:00,289 --> 00:02:01,479 called What's Your Client Thinking? 38 00:02:01,479 --> 00:02:04,979 And the very first one of those was the owner of a cat with chronic kidney 39 00:02:04,999 --> 00:02:08,659 disease, whose cat lived two and a half years longer than she thought it would. 40 00:02:08,660 --> 00:02:12,279 And at the beginning of this cat's illness trajectory, she took on doing 41 00:02:12,280 --> 00:02:14,739 all of these things, which she thought this is going to be fine because it's 42 00:02:14,739 --> 00:02:17,450 probably not going to sadly be for very long and I don't mind doing it. 43 00:02:17,705 --> 00:02:21,605 Two and a half years later, she was still doing all these things and the 44 00:02:21,665 --> 00:02:23,195 cat was having increasing problems. 45 00:02:23,195 --> 00:02:27,035 And she found it really hard to go away because it was such a big responsibility 46 00:02:27,035 --> 00:02:30,114 for somebody else to look after the cat, essentially to be making decisions 47 00:02:30,115 --> 00:02:31,644 on her behalf when she was away. 48 00:02:31,645 --> 00:02:36,825 And I think we really underestimate that plus also the concern that owners have 49 00:02:36,825 --> 00:02:41,275 as their pets, very much loved often, pets age around making quality of life 50 00:02:41,275 --> 00:02:45,365 decisions, around juggling different medications, different health needs, 51 00:02:45,605 --> 00:02:48,734 different priorities in a multi cat household particularly can be really 52 00:02:48,734 --> 00:02:51,325 challenging and trying to balance the needs and diets of different cats. 53 00:02:51,845 --> 00:02:54,774 So, I think there's lots and lots of things that we can talk about in these 54 00:02:54,774 --> 00:02:57,734 clinics, as well as just obviously focusing on the physical exam. 55 00:02:58,015 --> 00:03:01,075 Without the owner, we can't really do anything to fix the cat, so 56 00:03:01,075 --> 00:03:04,274 it's so important to have them on board and to make sure that they're 57 00:03:04,274 --> 00:03:05,644 as well supported as they can be. 58 00:03:05,644 --> 00:03:07,924 And there's a really big role for us in doing that, I think. 59 00:03:08,724 --> 00:03:11,215 Nathalie Dowgray: I think that's, that's really important to be 60 00:03:11,215 --> 00:03:14,564 considering that emotional load that you mentioned earlier as well. 61 00:03:14,894 --> 00:03:18,345 They're all things that we really need to be taking into consideration. 62 00:03:18,654 --> 00:03:19,064 Zoe Belshaw: Absolutely. 63 00:03:19,114 --> 00:03:23,274 There's no point having a gold standard, kind of inverted commas, care package. 64 00:03:23,274 --> 00:03:26,130 If it's something that the owner and the cat just can't do, you 65 00:03:26,130 --> 00:03:28,760 know, there's no point prescribing medication a cat can't take. 66 00:03:28,790 --> 00:03:32,609 There's no point setting up a series of consultations for a client who can't get 67 00:03:32,609 --> 00:03:36,079 the cat into a basket or who is really worried about transporting their cat. 68 00:03:36,120 --> 00:03:37,160 It's not going to happen. 69 00:03:37,440 --> 00:03:39,420 So contextualised care is so, so important. 70 00:03:39,459 --> 00:03:42,509 Looking at the cat, the owner and ourselves, what facilities we've got, 71 00:03:42,510 --> 00:03:46,490 what knowledge we have, what we can realistically provide and tailoring 72 00:03:46,500 --> 00:03:51,030 the care and not feeling that we need to be beholden to a specific set 73 00:03:51,060 --> 00:03:54,700 of guidance that somebody else has written that might just not be right. 74 00:03:54,755 --> 00:03:58,005 For, for us and for the pets in front of us, really important. 75 00:03:58,245 --> 00:04:01,295 Nathalie Dowgray: Some of the stuff we're talking about today is based on 76 00:04:01,310 --> 00:04:06,040 very much guidance and guidelines, but that contextualisation piece I think is 77 00:04:06,040 --> 00:04:10,010 always really important and I think as vets, maybe we sometimes get slightly 78 00:04:10,010 --> 00:04:13,349 hung up on that, what we should be doing, what's the best thing we should be doing 79 00:04:13,350 --> 00:04:18,834 in terms of that physical health, but the cat compliance and the owner buy 80 00:04:18,834 --> 00:04:22,625 in compliance, and ability to perform some of these things are equally as 81 00:04:22,625 --> 00:04:26,585 important and I think it's a balancing act between all those three factors 82 00:04:26,585 --> 00:04:29,885 and that's going to achieve the best outcome for the individual patient. 83 00:04:29,924 --> 00:04:32,194 So, I guess when we then start to think about senior 84 00:04:32,194 --> 00:04:33,924 clinics and wellness programs. 85 00:04:34,450 --> 00:04:37,719 What sort of ages do you think we should be starting to maybe increase 86 00:04:37,719 --> 00:04:42,099 the frequency of appointments or start to maybe expand on what we're doing 87 00:04:42,109 --> 00:04:44,460 within those regular wellness checks? 88 00:04:44,749 --> 00:04:46,450 Zoe Belshaw: You need to know who you're going to include in these for 89 00:04:46,450 --> 00:04:48,969 when you're going to be advertising and educating your team about it. 90 00:04:48,969 --> 00:04:53,099 And advice does vary quite widely as to when to start, and it may be 91 00:04:53,099 --> 00:04:54,399 dependent on your cat population. 92 00:04:54,400 --> 00:05:00,840 We know from surveys like the PDSA's pet Paw Survey that the number of cats 93 00:05:00,850 --> 00:05:04,180 presenting for routine consultations, such as boosters really drops off. 94 00:05:04,180 --> 00:05:06,710 So even just getting them through the door once a year is a great 95 00:05:07,010 --> 00:05:10,830 start, but International Cat Care define a mature cat as being about 96 00:05:10,830 --> 00:05:13,590 7 to 10, a senior cat as 11 to 14. 97 00:05:13,599 --> 00:05:16,795 And what used to be geriatric has now been rebranded, which I think 98 00:05:16,795 --> 00:05:21,895 is fantastic, as a super senior as 15 plus, and you can pick one of 99 00:05:21,895 --> 00:05:23,095 those time points very commonly. 100 00:05:23,095 --> 00:05:26,685 We know that mature cats do start to show these problems from 7 plus, 101 00:05:27,175 --> 00:05:31,204 so many clinics will initiate checks then, some will wait until they're 10. 102 00:05:31,255 --> 00:05:35,428 So potentially starting a check on an annual basis from 7 and then starting to 103 00:05:35,428 --> 00:05:40,570 move into potentially annual up to twice a year checks in that senior 11 to 14 104 00:05:40,600 --> 00:05:44,580 bracket, if you've got the right cat, the right owner and the right circumstances, 105 00:05:44,800 --> 00:05:48,870 even going up to three to four times a year in those super seniors, very much 106 00:05:48,870 --> 00:05:52,849 again, tailoring it on what the owner and the cat feel is right for them. 107 00:05:52,849 --> 00:05:54,179 And also what problems you've got. 108 00:05:54,469 --> 00:05:58,175 The more you screen them, the more you find, certainly I know from your work 109 00:05:58,375 --> 00:06:01,485 at Liverpool, what age do you enrol cats from in the Liverpool program? 110 00:06:01,485 --> 00:06:02,725 Nathalie Dowgray: Between 7 and 10. 111 00:06:02,765 --> 00:06:06,125 And we're now coming into our seventh year of data collection. 112 00:06:06,515 --> 00:06:10,445 So, the hope that the next stage of analysis and the work will be starting 113 00:06:10,445 --> 00:06:13,994 to refine a little bit more about what test and when, and it was really 114 00:06:13,994 --> 00:06:16,495 interesting when you said the more you look for things, the more you find, 115 00:06:16,735 --> 00:06:20,500 and within that cohort, part of what we were doing was including an orthopaedic 116 00:06:20,520 --> 00:06:22,800 assessment at each appointment as well. 117 00:06:23,260 --> 00:06:26,840 And whilst we weren't doing x-rays, we couldn't say definitively that 118 00:06:26,840 --> 00:06:29,930 these cats have osteoarthritis or degenerative joint disease. 119 00:06:30,280 --> 00:06:34,350 We were starting to see a really high number of them, over 50%, 120 00:06:34,770 --> 00:06:38,319 we're just showing changes on their orthopaedic assessment that may have 121 00:06:38,319 --> 00:06:41,870 indicated we need to be starting to think about osteoarthritis in cats. 122 00:06:42,360 --> 00:06:45,100 When we think about intensity of our appointments and what 123 00:06:45,100 --> 00:06:46,880 we should be doing test wise. 124 00:06:47,210 --> 00:06:50,800 If we start to be thinking about cats from sort of seven years of age, we 125 00:06:50,800 --> 00:06:54,989 found an awful lot of dental disease and potentially indications that 126 00:06:54,990 --> 00:06:58,799 their musculoskeletal system may be starting to experience some pain. 127 00:06:58,970 --> 00:07:02,580 And we may need to be looking at interventions on that as well. 128 00:07:02,610 --> 00:07:04,479 So, they were really common. 129 00:07:04,679 --> 00:07:06,560 But those are things that we don't necessarily need to 130 00:07:06,560 --> 00:07:08,500 do additional testing for. 131 00:07:08,510 --> 00:07:12,220 We need to be making sure that we're doing a really good thorough examination. 132 00:07:12,230 --> 00:07:16,350 So, I definitely agree with you that getting cats back into the 133 00:07:16,350 --> 00:07:17,990 vet clinic is really important. 134 00:07:18,739 --> 00:07:19,249 Zoe Belshaw: Yeah. 135 00:07:19,250 --> 00:07:22,329 So, I think probably just even starting to emphasise, we'd like to see your cat once 136 00:07:22,329 --> 00:07:26,609 a year between the ages, even of 7 and 10, even just if it's for a history take, 137 00:07:26,609 --> 00:07:31,640 a full clinical exam, a body condition score, a weight check, a muscle condition 138 00:07:31,640 --> 00:07:36,360 score, and a general chat without necessarily even needing to do any extra 139 00:07:36,360 --> 00:07:39,599 stuff at that point in time if there's no indication of any additional problems. 140 00:07:39,910 --> 00:07:42,709 But again, tailoring that for different owners, but then when they move into 141 00:07:42,709 --> 00:07:46,020 that more senior bracket, thinking about potentially building in more tests. 142 00:07:46,070 --> 00:07:48,960 So, very much rather than it being a one size fits all. 143 00:07:48,960 --> 00:07:51,170 And again, that might help people financially as well. 144 00:07:51,220 --> 00:07:53,980 There are advantages to seeing those cats, even just getting through the 145 00:07:53,980 --> 00:07:57,750 door to do what seems to us like the basics may be incredibly valuable 146 00:07:57,750 --> 00:07:59,640 for both the cat and the client. 147 00:08:00,595 --> 00:08:03,585 Nathalie Dowgray: That's I think a really important message that hopefully we'll 148 00:08:03,585 --> 00:08:07,165 reinforce during this podcast, because definitely when we found when we were 149 00:08:07,165 --> 00:08:11,214 enrolling for that ageing cohort, a lot of the cats from the population that we 150 00:08:11,215 --> 00:08:15,915 were recruiting from had been neutered and had kitten vaccines, and then they 151 00:08:15,915 --> 00:08:20,235 may have had one or two appointments where they'd been, a trauma incident 152 00:08:20,235 --> 00:08:24,445 or a cat bite abscess, but a large proportion of them weren't coming in for 153 00:08:24,445 --> 00:08:26,285 regular wellness checks, for boosters. 154 00:08:26,565 --> 00:08:30,755 So, and the other thing that I found quite interesting with it, we're perhaps seeing 155 00:08:30,755 --> 00:08:34,394 lower prevalence of some of the diseases that we thought we would be seeing in 156 00:08:34,394 --> 00:08:36,114 higher prevalence at this age range. 157 00:08:36,544 --> 00:08:41,015 And whilst we wouldn't consider ourselves an interventional study, just the fact 158 00:08:41,034 --> 00:08:45,415 that we've been providing free wellness checks on a biannual basis for some 159 00:08:45,415 --> 00:08:47,084 of these cats now the last six years. 160 00:08:47,605 --> 00:08:50,065 That in itself actually might have been an intervention. 161 00:08:50,125 --> 00:08:55,365 So, I think there's to me, potentially some benefits that we need to explore a 162 00:08:55,365 --> 00:08:59,874 little bit more and maybe get some more data on just getting cats through the 163 00:08:59,875 --> 00:09:02,095 door for a good, thorough examinations. 164 00:09:02,125 --> 00:09:05,575 I'll hopefully have some more interesting stuff to report on that in the future, but 165 00:09:05,795 --> 00:09:09,725 I'm definitely thinking at least at this point, there's just a benefit in that. 166 00:09:09,725 --> 00:09:10,315 Zoe Belshaw: Absolutely. 167 00:09:10,315 --> 00:09:10,939 I'm sure there is. 168 00:09:10,949 --> 00:09:14,040 I think any education is intervention and getting owners to just even be 169 00:09:14,040 --> 00:09:16,790 aware of what things you're looking for, what things to look out for. 170 00:09:17,300 --> 00:09:19,080 I would personally call that an intervention. 171 00:09:19,290 --> 00:09:21,900 So, I'm not particularly surprised because the more switched on 172 00:09:21,900 --> 00:09:23,030 owners are to look at things. 173 00:09:23,040 --> 00:09:27,059 Repeatedly in my PhD, I had owners saying like, when we go to a vet for an 174 00:09:27,059 --> 00:09:30,310 annual visit, what we'd really like is to be told what to look out for next. 175 00:09:30,660 --> 00:09:34,509 We don't necessarily want a review of what's going on and, oh, fantastic, isn't 176 00:09:34,509 --> 00:09:36,300 he doing well or everything's stable. 177 00:09:36,489 --> 00:09:38,170 We want to be told what's coming next. 178 00:09:38,170 --> 00:09:39,420 What do we need to look out for? 179 00:09:39,619 --> 00:09:42,569 And that's exactly what it sounds like you've done with your healthy aging clinic 180 00:09:42,569 --> 00:09:46,300 is to provide owners with that information about this is what we're looking for, this 181 00:09:46,300 --> 00:09:48,149 is what might come next at the next stage. 182 00:09:48,170 --> 00:09:50,529 If you see these things, this is what they might be. 183 00:09:50,529 --> 00:09:51,699 And this is what we need to do. 184 00:09:52,189 --> 00:09:55,509 We need to have as a thing, that's really going to proceed almost launching 185 00:09:55,509 --> 00:10:00,159 these clinics in a practice is really raising the awareness and educating 186 00:10:00,800 --> 00:10:03,500 our owners about the fact that there are many things that are thought to be 187 00:10:03,500 --> 00:10:04,930 just old age, and actually they're not. 188 00:10:04,959 --> 00:10:09,319 And it's not about us making money by trying to do tests and sell product. 189 00:10:09,360 --> 00:10:12,610 It's about really these things actually being things that the cats can be helped 190 00:10:12,610 --> 00:10:16,159 with if we diagnose them and can help them to live longer, healthier, happier lives. 191 00:10:16,439 --> 00:10:19,140 And that that will have less of an impact on your life as well if 192 00:10:19,199 --> 00:10:20,489 they're managing their conditions. 193 00:10:21,509 --> 00:10:24,490 Nathalie Dowgray: I think on our side, the reason why I didn't really think it was 194 00:10:24,490 --> 00:10:28,030 an intervention is because we were just asking questionnaire questions every year. 195 00:10:28,425 --> 00:10:29,625 But those were the questions. 196 00:10:29,635 --> 00:10:30,444 Have you seen this? 197 00:10:30,454 --> 00:10:31,375 Have you seen that? 198 00:10:31,425 --> 00:10:35,425 So naturally people were thinking, okay, this is something I need to look out for. 199 00:10:35,464 --> 00:10:39,104 What is an interesting thing, and then this is probably, I guess I would 200 00:10:39,105 --> 00:10:43,084 argue a little bit more apparent with cats than dogs is they are potentially 201 00:10:43,084 --> 00:10:45,174 quite good at hiding sides of disease. 202 00:10:45,564 --> 00:10:51,439 And so, there are some things that, until stuff gets quite bad, we won't necessarily 203 00:10:51,469 --> 00:10:53,280 know that this is starting to go on. 204 00:10:53,310 --> 00:10:57,520 Hypertension is probably a good example of that, target organ damage, acute blindness 205 00:10:57,530 --> 00:11:00,020 is often sometimes that first sign. 206 00:11:00,289 --> 00:11:03,749 So, when we start to think about what diagnostic tests we should include 207 00:11:03,799 --> 00:11:07,849 and when, what sort of recommendations would you be considering for those? 208 00:11:08,385 --> 00:11:11,095 Zoe Belshaw: Yeah, I think, as you said, there's lots of problems that cats are 209 00:11:11,145 --> 00:11:12,275 pretty good at hiding, aren't they? 210 00:11:12,275 --> 00:11:15,485 Hypertension being an excellent one that unless they get retinal detachment or 211 00:11:15,814 --> 00:11:19,054 some other sort of secondary problem associated with that, then it is pretty 212 00:11:19,055 --> 00:11:20,915 difficult for owners to spot these things. 213 00:11:20,915 --> 00:11:24,864 And similarly with some of the PUPD type problems, I really like Sarah 214 00:11:24,864 --> 00:11:27,734 Caney's advice that every older cat should have a litter tray in the house. 215 00:11:28,295 --> 00:11:32,285 Just so the owners can have a bit of an idea as to what a urine output is 216 00:11:32,285 --> 00:11:35,595 like, because many of these outdoor peeing cats, the owners may just have 217 00:11:35,635 --> 00:11:39,564 no idea what their thirst and their, and their urination is actually like. 218 00:11:39,964 --> 00:11:43,845 The diagnostic tests need to be informed by what potential 219 00:11:43,845 --> 00:11:45,705 problems these cats might have. 220 00:11:45,705 --> 00:11:49,405 And the big ones that we're going to commonly think about, I think, in older 221 00:11:49,405 --> 00:11:52,824 cats are going to be a hyperthyroidism, chronic kidney disease, hypertension, 222 00:11:52,824 --> 00:11:57,079 diabetes mellitus, which we know will increase in prevalence with age and 223 00:11:57,079 --> 00:12:00,160 owners are probably more likely to recognise them too, because they're 224 00:12:00,160 --> 00:12:04,270 going to be associated with probably clinical signs of thirst, urination, 225 00:12:04,270 --> 00:12:06,410 vocalisation, potentially weight changes. 226 00:12:06,449 --> 00:12:10,010 ISFM, International Cat Care have done some great work increasing 227 00:12:10,010 --> 00:12:12,759 our awareness of like looking at how they go up and down stairs and 228 00:12:13,089 --> 00:12:14,689 ability to jump and things like that. 229 00:12:14,689 --> 00:12:16,449 So that's another one on our radar. 230 00:12:16,999 --> 00:12:20,349 We've also got problems that we might not have thought about quite so much 231 00:12:20,409 --> 00:12:24,509 around cardiac disease, overweight and obesity, long claws, dental 232 00:12:24,509 --> 00:12:26,769 disease, deafness, constipation. 233 00:12:26,819 --> 00:12:31,250 So, when we're thinking about all of these things that might be going on, as ever, 234 00:12:31,250 --> 00:12:35,879 the really key diagnostic tests are going to be really a history, a clinical exam. 235 00:12:36,209 --> 00:12:39,419 I think those are the big things that we must make sure we always do. 236 00:12:40,030 --> 00:12:42,819 Similarly, doing a weight check, a body condition score, ideally 237 00:12:42,819 --> 00:12:46,230 a muscle condition score and the website Cat Care For Life's got 238 00:12:46,230 --> 00:12:48,949 some really nice information about what we can think about doing. 239 00:12:49,400 --> 00:12:51,890 But obviously then, depending on what we might find on a clinical 240 00:12:51,890 --> 00:12:55,610 exam, plus or minus, if we want to get into doing routine screening. 241 00:12:55,975 --> 00:12:59,355 We can think about including cystocentesis to check our urine 242 00:12:59,355 --> 00:13:01,525 specific gravity and our dipstick. 243 00:13:01,575 --> 00:13:04,445 If you can cysto a cat competently and confidently, then that's a 244 00:13:04,445 --> 00:13:05,814 really handy thing to be able to do. 245 00:13:06,165 --> 00:13:09,355 And equally haematology and biochemistry can certainly have their place. 246 00:13:09,665 --> 00:13:13,455 Certainly, absolutely, if they're guided by clinical examination, but also as a 247 00:13:13,455 --> 00:13:17,875 routine screening tool, we can use those to pick up these early signs of chronic 248 00:13:17,875 --> 00:13:21,735 kidney disease and other end organ damage that we might get from hypertension. 249 00:13:22,344 --> 00:13:25,614 There's a bolt on again, then if you've got a compliant cat, if you're confident, 250 00:13:25,634 --> 00:13:27,295 competent, you've got the right setting. 251 00:13:27,494 --> 00:13:30,554 Thinking about oscillometric blood pressure measurement too can be a 252 00:13:30,554 --> 00:13:33,884 really good adjunct to something else that we can think of doing. 253 00:13:33,884 --> 00:13:36,744 And similarly, ophthalmoscopy to just check those retina and 254 00:13:36,744 --> 00:13:37,864 see what can be going on there. 255 00:13:37,864 --> 00:13:40,970 So, I think there's a whole gamut of different tests we can perform, 256 00:13:41,250 --> 00:13:44,209 whether we should perform every test on every cat in every clinic. 257 00:13:44,220 --> 00:13:47,959 I think probably we shouldn't, but I think we should always do the history taking. 258 00:13:47,959 --> 00:13:51,670 We should always do the clinical exam and we should always ask those 259 00:13:51,699 --> 00:13:55,150 open questions of owners saying, is there anything you're worried about? 260 00:13:55,479 --> 00:13:57,030 Is there anything that you think's changed? 261 00:13:57,049 --> 00:13:58,579 Is there any questions that you've got? 262 00:13:59,005 --> 00:14:01,885 Is there anything that you think you'd like to know about between the period 263 00:14:01,885 --> 00:14:04,325 of this examination and the next one? 264 00:14:04,555 --> 00:14:07,685 Because it's those kinds of pauses and those open questions that actually may 265 00:14:07,695 --> 00:14:10,934 point to some of the big things that you might not necessarily pick up in your 266 00:14:10,934 --> 00:14:14,724 history or clinical exam, or that might be something that's a really tiny thing, but 267 00:14:14,724 --> 00:14:16,284 it's a really big problem for the owner. 268 00:14:16,284 --> 00:14:18,884 And that might be the, yeah, my cat can't get out the cat flap anymore. 269 00:14:18,885 --> 00:14:22,655 It started yowling at two in the morning and it's waking me up and it's making it 270 00:14:22,665 --> 00:14:24,345 dangerous for me to drive to work because. 271 00:14:25,345 --> 00:14:26,275 I'm really struggling. 272 00:14:26,295 --> 00:14:29,745 We can use a questionnaires as, as you said, you do at Liverpool. 273 00:14:29,785 --> 00:14:33,405 So it's a mix of, yeah, history, clinical exam, and then those adjunct 274 00:14:33,405 --> 00:14:37,944 haematology, biochemistry, cysto, blood pressure, and, and ophthalmoscopy. 275 00:14:38,144 --> 00:14:40,884 Plus, I imagine if you want to do ortho exams, if you've got indications 276 00:14:40,884 --> 00:14:43,834 for that, whether that's physical exam again, or whether it's having a 277 00:14:43,935 --> 00:14:47,185 place that a cat can run around and climb and really just observing them 278 00:14:47,444 --> 00:14:50,014 in your consulting room, seeing what they're up to, checking the coat. 279 00:14:50,780 --> 00:14:51,760 All of those bits and bobs. 280 00:14:51,830 --> 00:14:54,170 Nathalie Dowgray: Yeah, I think that's often the take home message from this. 281 00:14:54,170 --> 00:14:57,660 You can get a lot from cats if you're able to do a good thorough physical exam. 282 00:14:57,660 --> 00:15:00,059 And I'll just do a quick plug for the Cat Friendly Clinic 283 00:15:00,059 --> 00:15:01,230 Scheme on that one as well. 284 00:15:01,230 --> 00:15:04,719 Because the happier the cat is in the vet clinic, the easier it is to 285 00:15:04,719 --> 00:15:06,680 do a full clinical exam on them too. 286 00:15:06,770 --> 00:15:07,410 Zoe Belshaw: Absolutely. 287 00:15:07,970 --> 00:15:09,299 A useful one to consider. 288 00:15:09,300 --> 00:15:12,540 And I think something that's really good advice was to make sure that 289 00:15:12,570 --> 00:15:16,460 owners are really confident in how to transport a cat to the clinic. 290 00:15:16,839 --> 00:15:19,649 And that again is, is something that we can all do, but owners may 291 00:15:19,649 --> 00:15:22,910 be really worried about how to get the cat in the carrier, how to get 292 00:15:22,920 --> 00:15:25,409 the carrier in the car, whether the cat's going to soil itself. 293 00:15:25,409 --> 00:15:29,850 Cause if you've got a cat that's arrived, stressed out, covered in poo that 294 00:15:29,870 --> 00:15:33,170 you can't get out of the box, you can still do a really good history take. 295 00:15:33,230 --> 00:15:35,320 You can still observe the cat. 296 00:15:35,380 --> 00:15:37,799 You can still potentially weigh the cat, but you're going to be pretty 297 00:15:37,799 --> 00:15:39,170 limited in what else you can do. 298 00:15:39,549 --> 00:15:42,250 And it may be that having had that experience once, the owner is going to 299 00:15:42,250 --> 00:15:45,169 say, do you know what, I am absolutely not going to opt into doing this four 300 00:15:45,169 --> 00:15:46,619 times a year, like that's not me. 301 00:15:47,009 --> 00:15:50,290 Making sure before you start that they've got all of that information, that they're 302 00:15:50,290 --> 00:15:52,110 confident about getting the cat to you. 303 00:15:52,400 --> 00:15:55,530 And as you say, absolutely having the right waiting room set up and 304 00:15:55,530 --> 00:15:58,320 thinking about all of those things that cats need to make them calm in 305 00:15:58,320 --> 00:15:59,680 a clinical setting is so important. 306 00:15:59,960 --> 00:16:03,140 And anybody booking these needs to be getting leaflets, information, and just 307 00:16:03,200 --> 00:16:05,930 even a phone call to just check that they're happy to get the cat to you. 308 00:16:05,930 --> 00:16:08,190 And to give advice, it can start when these are kittens. 309 00:16:08,230 --> 00:16:11,089 Having done that early on, you'll then much more easily be able to get 310 00:16:11,089 --> 00:16:13,770 these cats keeping coming back to you because they'll be happy to travel. 311 00:16:14,500 --> 00:16:15,899 Nathalie Dowgray: That's a really important point. 312 00:16:15,929 --> 00:16:17,060 Every cat's an individual. 313 00:16:17,090 --> 00:16:21,340 One of the barriers we found, even with offering a free service, sometimes there's 314 00:16:21,340 --> 00:16:23,640 a fear that we're going to find something. 315 00:16:24,010 --> 00:16:30,680 And so there's the piece to discuss around how we can be communicating our findings, 316 00:16:30,680 --> 00:16:34,250 whether we haven't found anything or we have found something and how we 317 00:16:34,250 --> 00:16:36,180 can maybe allay some of those fears. 318 00:16:36,590 --> 00:16:37,660 Zoe Belshaw: Yeah, definitely. 319 00:16:37,710 --> 00:16:40,480 I think that's a really big one, that some owners may avoid 320 00:16:40,509 --> 00:16:41,900 presenting their pet to the clinic. 321 00:16:41,960 --> 00:16:45,019 Certainly, when I was working in the PDSA, that was a relatively common thing 322 00:16:45,040 --> 00:16:48,425 that, unfortunately, we'd get animals presented with very late stage disease 323 00:16:48,444 --> 00:16:52,055 because other owners had learned from their neighbours that they took their pet 324 00:16:52,064 --> 00:16:53,784 to the vets and their pet was euthanized. 325 00:16:53,785 --> 00:16:56,755 And that kind of led to a self-perpetuating thing in certain 326 00:16:56,765 --> 00:16:59,465 small communities where these animals were only being presented with 327 00:16:59,505 --> 00:17:02,204 such late stage disease that there really was nothing that we could do. 328 00:17:02,205 --> 00:17:05,090 And it was really hard to break that cycle because it did 329 00:17:05,090 --> 00:17:06,590 positively reinforce itself. 330 00:17:06,590 --> 00:17:08,960 That if you wait until you've got a large ulcerated mass, then 331 00:17:08,960 --> 00:17:11,690 unfortunately it may be really hard for us to be able to do anything. 332 00:17:12,209 --> 00:17:15,990 And so I think owners are going to be worried about finding something, 333 00:17:16,010 --> 00:17:19,370 but I think emphasising the fact that we've getting better and better at 334 00:17:19,509 --> 00:17:23,409 feline medicine now, and there are more and more solutions, cats can live 335 00:17:23,755 --> 00:17:26,535 happily and healthily with a lot of these diseases, whether it's chronic 336 00:17:26,565 --> 00:17:29,485 kidney disease, whether it's diabetes mellitus, whether it's hypertension, 337 00:17:29,515 --> 00:17:31,045 we've got treatments for these things. 338 00:17:31,495 --> 00:17:35,655 So I think emphasising that these things are really common and that the majority 339 00:17:35,655 --> 00:17:39,826 of cats will have something and that there is something that you can do and that 340 00:17:39,826 --> 00:17:41,284 there are multiple different solutions. 341 00:17:41,615 --> 00:17:44,705 For many of these different problems, there'll be different formulations of 342 00:17:44,705 --> 00:17:47,575 medication, there'll be different ways of managing problems, potentially, 343 00:17:47,575 --> 00:17:48,885 I think is really important. 344 00:17:49,415 --> 00:17:52,325 As we age, we almost always get something, but it doesn't necessarily 345 00:17:52,325 --> 00:17:57,095 mean that it's going to be a serious thing, or if it is a serious thing, then 346 00:17:57,379 --> 00:18:00,540 much better for us to find it sooner and be able to do something about it. 347 00:18:00,950 --> 00:18:04,620 And equally, if we don't find anything, then we can absolutely celebrate success. 348 00:18:04,620 --> 00:18:08,049 And yes, there can be some owner framing of the fact that I've spent 349 00:18:08,049 --> 00:18:10,660 all this money and now you didn't find anything and it was a waste of money. 350 00:18:10,660 --> 00:18:14,850 And I think we can tend probably to worry more about that 351 00:18:14,859 --> 00:18:16,179 actually than our owners do. 352 00:18:16,199 --> 00:18:19,620 You can be really delighted actually for the owner and the cat that, that 353 00:18:19,705 --> 00:18:22,935 you didn't find anything and that they've got a clean bill of health. 354 00:18:22,975 --> 00:18:27,735 I would hope that owners would be really happy about it, but it's also again, 355 00:18:27,745 --> 00:18:31,885 really important that you are taking the time to educate and inform owners. 356 00:18:31,905 --> 00:18:35,145 So even if you haven't found anything on clinical exam, making sure you've 357 00:18:35,155 --> 00:18:38,985 taken that time to be able to answer any questions they have, discuss any 358 00:18:38,985 --> 00:18:42,485 concerns and provide them with free advice or make it feel that your advice 359 00:18:42,495 --> 00:18:43,524 is something that they've paid for. 360 00:18:43,534 --> 00:18:45,924 Nathalie Dowgray: There's a lot of advice, especially around things like 361 00:18:45,925 --> 00:18:49,964 dietary changes, cats are getting older or how we can be modifying the 362 00:18:49,965 --> 00:18:54,749 home environment, especially when we consider how prevalent um, osteoarthritis 363 00:18:54,749 --> 00:18:56,449 is in cats as they get older. 364 00:18:56,659 --> 00:19:00,559 And even if they're not at the stage that we feel that an intervention like a non 365 00:19:00,559 --> 00:19:05,360 steroidal or another type of analgesia is required, there's a lot we can do in terms 366 00:19:05,360 --> 00:19:10,259 of advice around maybe dietary changes or home environmental modification as well. 367 00:19:10,550 --> 00:19:14,505 And I think that communication piece is, is really useful. 368 00:19:14,755 --> 00:19:18,235 I always find the dietary one quite interesting because again, there 369 00:19:18,235 --> 00:19:20,885 can be this perception that we're trying to sell them something. 370 00:19:21,194 --> 00:19:24,545 How do you fit dietary advice into your consultations? 371 00:19:24,705 --> 00:19:27,404 Zoe Belshaw: Yeah, I think it's really tricky and cats can be so fussy 372 00:19:27,404 --> 00:19:29,944 and owners can be so delighted that they finally found something that 373 00:19:29,945 --> 00:19:34,060 cats will consistently eat, that I'm cautious to chuck that all away and 374 00:19:34,060 --> 00:19:36,210 replace it with a bag of something that's got the word veterinary on it. 375 00:19:36,210 --> 00:19:38,820 But certainly adding, increasing moisture content can be a really good 376 00:19:38,820 --> 00:19:42,050 idea, whether that's adding just a little bit of extra water to cat food. 377 00:19:42,080 --> 00:19:44,910 That can be one of the most useful things I think that we can do in these 378 00:19:44,930 --> 00:19:48,570 senior cats to reduce the risk of constipation and keep that water going. 379 00:19:48,650 --> 00:19:51,810 And really important again, with any of these things, look at the snacks 380 00:19:51,820 --> 00:19:54,370 that these animals are getting, because there's no point spending a 381 00:19:54,390 --> 00:19:58,775 fortune on a specific bag of veterinary food where the cat's having 25 382 00:19:58,815 --> 00:20:00,185 packets of Dreamies a day, you know? 383 00:20:00,815 --> 00:20:02,825 So it's getting that balance right. 384 00:20:02,825 --> 00:20:05,744 And again, thinking about whether that really is the best thing 385 00:20:05,745 --> 00:20:08,865 for the animal and then what the client wants, what they can manage. 386 00:20:08,865 --> 00:20:10,304 How many other cats there are in the house? 387 00:20:10,305 --> 00:20:14,474 Are you going to be feeding 25 cats on a renal diet if it's a multi cat household? 388 00:20:14,535 --> 00:20:17,504 So, it's really a case of talking to the owner and really 389 00:20:17,515 --> 00:20:19,735 thinking through the day and how practically they're going to manage. 390 00:20:20,004 --> 00:20:22,305 So many of these cats, that we haven't really covered yet, are 391 00:20:22,665 --> 00:20:25,145 multimorbid, they've got loads of different problems going on at once. 392 00:20:25,175 --> 00:20:28,774 So you might be trying to trade off your hyperthyroidism, your osteoarthritis, 393 00:20:28,774 --> 00:20:31,684 your early stage chronic kidney disease, plus or minus diabetes 394 00:20:31,874 --> 00:20:35,844 mellitus, they might be constipated and they might be a mainly outdoor 395 00:20:35,844 --> 00:20:37,824 cat that's a really hard to medicate. 396 00:20:38,225 --> 00:20:41,884 And a lot of the time, with these animals, we are having to just try to 397 00:20:41,935 --> 00:20:46,564 juggle all of these different conditions that may on paper require really 398 00:20:46,614 --> 00:20:48,814 contrasting, conflicting management plans. 399 00:20:49,295 --> 00:20:51,964 And it's really important to keep stepping back and seeing this cat 400 00:20:51,965 --> 00:20:55,424 as a whole rather than a series of semi-broken, semi-functional body 401 00:20:55,424 --> 00:20:58,495 parts and think, well, what's going to work for this individual cat exactly? 402 00:20:58,584 --> 00:20:59,954 What's going to work for this household? 403 00:21:00,365 --> 00:21:03,565 Which is the most important of these diseases for me to focus on. 404 00:21:03,565 --> 00:21:07,145 And actually, that might mean I've got to drop the ball a bit on this one, but 405 00:21:07,165 --> 00:21:10,635 this is the one at the moment that's currently impacting this cat's quality 406 00:21:10,635 --> 00:21:14,564 of life more and is likely to impact this cat's quality of life in the future. 407 00:21:14,564 --> 00:21:18,094 And it may be, you may be managing one really well for a while and letting 408 00:21:18,094 --> 00:21:20,845 another one slide a little bit and then picking up that other one as 409 00:21:20,845 --> 00:21:24,555 the significance for that individual cat becomes more substantial. 410 00:21:24,595 --> 00:21:27,290 So, yeah, it is really tricky. 411 00:21:27,290 --> 00:21:30,709 And the fact that we've now got diets that are a bit more blended is so 412 00:21:30,719 --> 00:21:33,620 helpful rather than it being, you hypothetically need to get out six 413 00:21:33,620 --> 00:21:36,679 different packets for the same cat because it's got all the different conditions. 414 00:21:36,699 --> 00:21:38,669 So yeah, definitely that's, that's a big improvement. 415 00:21:39,179 --> 00:21:39,559 Nathalie Dowgray: Yeah. 416 00:21:39,559 --> 00:21:42,899 And I think what is the piece that's having the most significant impact on 417 00:21:43,130 --> 00:21:44,959 the cat's health and quality of life? 418 00:21:45,469 --> 00:21:47,739 And focusing on that is really important. 419 00:21:47,769 --> 00:21:49,320 We all attend quite a lot of CPD. 420 00:21:49,320 --> 00:21:53,159 And I think one of the more engaging ones I went to once was a series of, 421 00:21:53,179 --> 00:21:57,949 of cases with cats with comorbidities and trying to work out what was 422 00:21:57,949 --> 00:21:59,519 the best diet to put them on. 423 00:21:59,840 --> 00:22:01,449 And it really made your brain work. 424 00:22:01,459 --> 00:22:03,759 Cause they were like, Oh, I would have done that reflexively. 425 00:22:03,919 --> 00:22:05,090 But actually they're right. 426 00:22:05,100 --> 00:22:08,580 This is the one that probably needs the more dietary focus on. 427 00:22:08,580 --> 00:22:10,509 So, I think that piece is really interesting. 428 00:22:10,509 --> 00:22:15,850 And as part of my PhD work, I attended a few human ageing research conferences. 429 00:22:15,850 --> 00:22:18,839 And one of the things that I found really interesting, one of those was where 430 00:22:18,959 --> 00:22:22,519 they were talking about this decreased thirst signalling in older people. 431 00:22:22,889 --> 00:22:26,090 And we see all the warnings every time Britain has a heat wave, 432 00:22:26,129 --> 00:22:28,979 especially focusing on older people to make sure that they are drinking 433 00:22:28,979 --> 00:22:32,469 properly because dehydration becomes a big complicating factor. 434 00:22:33,355 --> 00:22:36,544 And when we think about cats, you mentioned constipation earlier on as an 435 00:22:36,544 --> 00:22:41,054 issue that we see, and there's that pain related element with osteoarthritis that 436 00:22:41,064 --> 00:22:43,185 may cause them to hold on a little bit. 437 00:22:43,465 --> 00:22:47,285 But also, there's the fluid loss with chronic kidney disease and the fact 438 00:22:47,285 --> 00:22:49,934 that they're probably not drinking as much as what they should do. 439 00:22:50,695 --> 00:22:55,075 And so, I don't think I'm aware of anything that proves that cats have that. 440 00:22:55,575 --> 00:22:58,305 My suspicion is that they probably do. 441 00:22:59,115 --> 00:23:00,355 Zoe Belshaw: Yeah, it's really interesting. 442 00:23:00,355 --> 00:23:02,875 And it's something that we all probably need to just be more and more mindful 443 00:23:02,875 --> 00:23:05,955 of with climate change really, we're getting these, these hot spells 444 00:23:05,955 --> 00:23:08,844 and we see the advice for elderly people to drink more and stay cool. 445 00:23:08,855 --> 00:23:12,365 We're good at telling owners of dogs, not to walk them in the heat, but yeah, 446 00:23:12,365 --> 00:23:15,804 thinking about proactively advising owners of senior cats to up their water 447 00:23:15,804 --> 00:23:19,145 intake during these hot spells, especially if there are cats that prefer to drink 448 00:23:19,335 --> 00:23:22,625 water sources from outside that will potentially evaporate a lot more quickly. 449 00:23:22,875 --> 00:23:24,765 So that's probably another piece that maybe we're not 450 00:23:24,765 --> 00:23:25,985 doing quite enough with there. 451 00:23:26,035 --> 00:23:28,495 Nathalie Dowgray: I think people are always a little bit surprised when I say 452 00:23:28,545 --> 00:23:32,674 I'm a big fan of feeding cats a mixed wet and dry diet, but that was always 453 00:23:32,685 --> 00:23:36,385 part of my reasoning that actually that water intake piece as they get older 454 00:23:36,685 --> 00:23:38,445 is a really useful one to consider. 455 00:23:38,445 --> 00:23:39,665 And I think you are right. 456 00:23:39,765 --> 00:23:41,675 It's definitely a part of the world that we're going to 457 00:23:41,685 --> 00:23:43,814 have to be more proactive in. 458 00:23:43,904 --> 00:23:47,764 If let's say people listening to the podcast to become inspired and they want 459 00:23:47,774 --> 00:23:52,185 to start maybe doing a bit more senior testing or getting a senior clinic going 460 00:23:52,245 --> 00:23:56,504 in their clinic, what sort of tips and advice would you give them to do that? 461 00:23:57,504 --> 00:24:01,150 Zoe Belshaw: I think it's really important to have a load of foundations 462 00:24:01,180 --> 00:24:03,450 before you even start by opening your door, which we've already 463 00:24:03,450 --> 00:24:04,970 discussed potential age bands. 464 00:24:05,200 --> 00:24:06,990 You need to think about who is going to run them. 465 00:24:07,410 --> 00:24:10,240 The challenge, certainly in the United Kingdom, that veterinary nurses are 466 00:24:10,240 --> 00:24:12,300 not allowed to make a formal diagnosis. 467 00:24:12,709 --> 00:24:16,649 And so, whilst it's fantastic to have nurses running ageing clinics 468 00:24:16,650 --> 00:24:20,409 because nurses really well trained in these things, they can be great 469 00:24:20,409 --> 00:24:23,899 communicators, owners can be much less concerned potentially about raising 470 00:24:23,899 --> 00:24:28,230 issues with nurses than they would be about vets because they may feel that 471 00:24:28,230 --> 00:24:31,010 the nurse can't, you know, rush them into doing something quite so much. 472 00:24:31,469 --> 00:24:34,439 But equally, it can lead to challenges where a nurse needs to 473 00:24:34,439 --> 00:24:37,939 make a diagnosis or finds an abdomen mass or see something that they're 474 00:24:37,939 --> 00:24:40,570 concerned about and then needs to get a vet to come and sign it off. 475 00:24:41,485 --> 00:24:44,885 When we're talking about osteoarthritic cats, for example, many of these 476 00:24:44,885 --> 00:24:48,005 cats, the owners report that they're stiff or they might be stiff and 477 00:24:48,285 --> 00:24:51,354 you can't necessarily diagnose osteoarthritis as a veterinary nurse, 478 00:24:51,354 --> 00:24:52,755 but you certainly can diagnose stiff. 479 00:24:53,295 --> 00:24:56,204 Therefore, here's all of the environmental modifications we could do. 480 00:24:56,484 --> 00:24:58,244 But I think that's a really big one to think about. 481 00:24:58,284 --> 00:25:00,394 If you've got nurses who are running the clinics, what are they going 482 00:25:00,395 --> 00:25:02,315 to do if they find a problem? 483 00:25:02,725 --> 00:25:05,665 Have you got enough nurses consistently available who are going 484 00:25:05,665 --> 00:25:07,305 to be happy to be client facing? 485 00:25:08,165 --> 00:25:11,695 And then if it's going to be vets doing it, then is it 486 00:25:11,695 --> 00:25:12,815 going to be separate clinics? 487 00:25:12,875 --> 00:25:16,014 Is it going to be something that's just available as and when an owner wants it? 488 00:25:16,044 --> 00:25:20,700 Or are you going to say, you know, open the doors at half past two on a Tuesday 489 00:25:20,700 --> 00:25:25,870 and say, that's my senior cat hour, because I think there's pros and cons. 490 00:25:25,870 --> 00:25:28,449 It's really important for your clinic to work out exactly 491 00:25:28,449 --> 00:25:29,139 how they're going to work. 492 00:25:29,169 --> 00:25:33,430 Because the worst thing to do is have vets that don't know when to recommend it. 493 00:25:33,450 --> 00:25:36,860 Have receptionists that don't know when to recommend them, have clients turning 494 00:25:36,860 --> 00:25:40,010 up and then there not be the right person available or the right kit available. 495 00:25:40,440 --> 00:25:44,550 So, practice meeting, who's going to run them, who's going to be included, what 496 00:25:44,550 --> 00:25:48,410 tests are going to be included, what's going to happen if you find a problem. 497 00:25:48,410 --> 00:25:51,090 Have you got a protocol for whether it's a vet or a nurse? 498 00:25:51,090 --> 00:25:52,930 What's the next step for each of those things? 499 00:25:53,360 --> 00:25:56,270 Potentially thinking about developing a questionnaire, sent that in advance 500 00:25:56,300 --> 00:25:59,689 by email before they come in, or that the nurse or the vet uses that as a 501 00:25:59,689 --> 00:26:03,349 standardised tool, so that we're always checking over the same things again. 502 00:26:03,629 --> 00:26:06,150 Make sure you've got the right leaflets in place to give advice. 503 00:26:06,480 --> 00:26:10,604 Some clinics are including these in, sort of, pet health clubs, 504 00:26:10,814 --> 00:26:12,324 so that's pseudo free of charge. 505 00:26:12,324 --> 00:26:13,534 You pay your monthly subscription. 506 00:26:13,534 --> 00:26:16,235 And then when the pet hits senior, the price goes up a little bit, 507 00:26:16,235 --> 00:26:19,685 but these clinics are effectively free because you're, you're paying 508 00:26:19,685 --> 00:26:23,594 that just monthly subscription versus others will charge for that. 509 00:26:24,004 --> 00:26:27,065 And you've got to think about whether you're going to discount the charging 510 00:26:27,345 --> 00:26:31,755 for a package of tests versus how much those individual tests would cost were 511 00:26:31,755 --> 00:26:35,145 you to just come straight through the vet for a non-health screening and be 512 00:26:35,145 --> 00:26:38,385 very transparent about what's included, what's not, how much it's going to 513 00:26:38,385 --> 00:26:42,184 cost and be really clear as to what the pathways are going to be for next steps. 514 00:26:42,184 --> 00:26:44,554 Walk yourself through this before you start setting up. 515 00:26:44,565 --> 00:26:47,855 It's really easy to have one enthusiastic staff member who says, 516 00:26:47,855 --> 00:26:48,925 yeah, I'm going to take it on. 517 00:26:48,965 --> 00:26:51,535 And for a senior vet to be like, yeah, brilliant. 518 00:26:51,785 --> 00:26:53,015 Off you go, run with it. 519 00:26:53,450 --> 00:26:57,110 You take ownership of this fantastic ,and that poor person then can be left 520 00:26:57,250 --> 00:27:01,389 standing in a consulting room with nobody booked to come in because the 521 00:27:01,389 --> 00:27:04,799 communications to the rest of the practice haven't been there to support them. 522 00:27:04,799 --> 00:27:06,719 Or that person goes on mat leave or leaves. 523 00:27:06,719 --> 00:27:09,679 And then what had been a really successful clinic falls apart because 524 00:27:09,679 --> 00:27:11,269 nobody else wanted to take it on board. 525 00:27:11,379 --> 00:27:14,930 So I think, yeah, everybody in the whole practice needs to be on board. 526 00:27:14,930 --> 00:27:19,425 You need to educate everybody from reception through to the most senior vet 527 00:27:19,455 --> 00:27:23,765 as to, to what's included, to signpost these things and be really confident 528 00:27:23,765 --> 00:27:28,014 that everybody is on board with what isn't included, how they run, so that 529 00:27:28,024 --> 00:27:31,125 you're getting a consistent approach every time these clients come in. 530 00:27:31,844 --> 00:27:35,340 So, sorry, that was a quite a long thing and it makes it sound a bit 531 00:27:35,490 --> 00:27:37,300 daunting and hard, but it shouldn't be. 532 00:27:37,300 --> 00:27:40,110 But there are so many, unfortunately, of these types of clinics that 533 00:27:40,149 --> 00:27:43,600 don't succeed or that reach a block in the road where people think, Oh 534 00:27:43,600 --> 00:27:44,770 yeah, we've got it all ready to go. 535 00:27:44,770 --> 00:27:46,469 And, and then nobody comes. 536 00:27:46,519 --> 00:27:50,289 It's so, so important to have that foundation and to be advertising them 537 00:27:50,289 --> 00:27:53,879 in the right way through Facebook, through the reception desk and through 538 00:27:53,909 --> 00:27:55,209 the vets in the consulting rooms. 539 00:27:55,620 --> 00:27:59,965 Really selling it with the right language that it's not just about testing. 540 00:27:59,965 --> 00:28:01,155 It's not just about screening. 541 00:28:01,155 --> 00:28:03,405 It's that opportunity to come and have a chat. 542 00:28:03,595 --> 00:28:05,284 We'll teach you about what to look for. 543 00:28:05,285 --> 00:28:07,465 We can help you with any problems that you've got. 544 00:28:07,805 --> 00:28:10,495 Potentially even thinking about setting up a senior cat club so that 545 00:28:10,544 --> 00:28:14,474 owners can talk to each other and share problems, their advice and tips. 546 00:28:14,475 --> 00:28:17,335 And even thinking about having a once a month tea club or something like 547 00:28:17,475 --> 00:28:20,215 that, where people leave their cats at home and just come in and have a chat 548 00:28:20,215 --> 00:28:24,285 and share tips about how to manage a diabetic cat or what it's like to live 549 00:28:24,285 --> 00:28:27,545 with a cat with cognitive dysfunction and allowing owners to feel like they're 550 00:28:27,545 --> 00:28:29,525 part of something bigger than themselves. 551 00:28:30,780 --> 00:28:34,080 Nathalie Dowgray: I think that's, your point around that agreement 552 00:28:34,190 --> 00:28:39,010 and consistency and all of that is a huge part of the momentum, isn't it? 553 00:28:39,060 --> 00:28:43,070 Owners get frustrated if they're getting a different message every 554 00:28:43,070 --> 00:28:44,229 time they're coming through. 555 00:28:44,230 --> 00:28:46,509 So I think consistency is important. 556 00:28:46,890 --> 00:28:50,520 And I think it is important to consider all of those other complicating factors, 557 00:28:50,740 --> 00:28:55,325 because currently, we're in an environment where we're short on clinical staff, and 558 00:28:55,325 --> 00:28:59,435 that momentum, that ability to be able to keep things running is really important. 559 00:28:59,885 --> 00:29:02,665 I think you raised a really nice point at the end there around that 560 00:29:02,665 --> 00:29:07,880 sort of peer support as well, and we know that senior cats, they have a 561 00:29:07,890 --> 00:29:12,360 massive benefit to their owners as well, that sort of human animal bond. 562 00:29:12,590 --> 00:29:15,920 If the pets are ageing well and they're invested in their pet's health, that 563 00:29:15,940 --> 00:29:18,299 also helps their own health as well. 564 00:29:18,560 --> 00:29:21,669 And I think we can agree that mental health support of having 565 00:29:21,669 --> 00:29:23,610 a pet is really positive. 566 00:29:23,829 --> 00:29:25,869 There's also potentially sometimes a mental health 567 00:29:25,870 --> 00:29:26,730 concern when your pet's unwell. 568 00:29:27,650 --> 00:29:30,660 So, the more we can do to support their healthy pet, I think the 569 00:29:30,660 --> 00:29:32,830 better it is for their owner as well. 570 00:29:33,160 --> 00:29:34,190 Zoe Belshaw: Yeah, I completely agree. 571 00:29:34,200 --> 00:29:36,450 It's certainly that mental health downside for some of these owners of 572 00:29:36,450 --> 00:29:39,640 older pets, where they're worried about what might happen, especially elderly 573 00:29:39,640 --> 00:29:42,539 owners who are worried about how they're going to cope with giving that care. 574 00:29:42,640 --> 00:29:45,989 As cats are living longer and longer, elderly people may have acquired cats 575 00:29:46,080 --> 00:29:50,049 relatively late in their own age and may be quite concerned about how they're going 576 00:29:50,049 --> 00:29:53,557 to happen if they need to go into hospital and providing support and information 577 00:29:53,557 --> 00:29:57,179 about options available, whether that's The Cinnamon Trust in the UK. 578 00:29:57,320 --> 00:30:00,310 Whether you've got peripatetic nurses, you could go and help 579 00:30:00,600 --> 00:30:02,140 visits at home, that kind of thing. 580 00:30:02,190 --> 00:30:03,740 All of those things are so important. 581 00:30:03,790 --> 00:30:06,879 I think can, can really lead to a mental health burden actually for owners of 582 00:30:06,880 --> 00:30:10,929 elderly pets, the owner of the older pet can increasingly get, get quite 583 00:30:10,930 --> 00:30:13,840 worried and upset if they don't feel they're being supported, or they haven't 584 00:30:13,840 --> 00:30:15,109 got the information that they need. 585 00:30:15,119 --> 00:30:17,140 They're not quite sure what the plan's going to be next. 586 00:30:17,370 --> 00:30:20,700 They're worried about what the vet or the nurse might say the next time they go in. 587 00:30:20,710 --> 00:30:22,980 They're worried that they might say that's the end or they're worried 588 00:30:22,980 --> 00:30:26,685 they're going to get pushed into doing a test they can't afford or worried 589 00:30:26,685 --> 00:30:29,645 they're going to get given medication they just can't dispense, yeah. 590 00:30:30,075 --> 00:30:34,524 All of those things that are super duper important to cover and to allay fears 591 00:30:34,525 --> 00:30:38,565 about teaching owners about how to pill cats if they've not done it before, 592 00:30:38,824 --> 00:30:44,125 giving them links to really helpful websites can all just be such tiny 593 00:30:44,175 --> 00:30:47,045 things that make these clinics a success. 594 00:30:47,520 --> 00:30:49,700 Rather than a, I'll come once then I'm not coming back. 595 00:30:49,760 --> 00:30:52,380 Nathalie Dowgray: We have to reframe some of this when we think about the 596 00:30:52,390 --> 00:30:54,570 current economic climate as well. 597 00:30:54,810 --> 00:30:57,420 Everyone's in a situation where their money isn't going 598 00:30:57,420 --> 00:30:58,829 as far as what it used to. 599 00:30:59,490 --> 00:31:03,949 So, what would be your sort of final thoughts on how we can convince clients 600 00:31:03,960 --> 00:31:08,815 that this is a worthwhile investment of both their time and their money? 601 00:31:10,135 --> 00:31:10,945 Zoe Belshaw: Yeah, I think it's hard. 602 00:31:10,945 --> 00:31:15,375 And I wonder if increasingly we do need to do a tiered approach where you potentially 603 00:31:15,375 --> 00:31:20,595 even just offer the history clinical exam, weight check as a one level. 604 00:31:20,865 --> 00:31:24,815 And then, have the option to do the other things, albeit that it's not ideal. 605 00:31:24,815 --> 00:31:27,345 It would be better, you know, it's this idea of gold standard versus 606 00:31:27,345 --> 00:31:30,915 contextualised care again, if the only clinic that you offer is all 607 00:31:30,915 --> 00:31:34,274 the bells and whistles that it's got to be cystocentesis, oscillometric 608 00:31:34,274 --> 00:31:35,694 blood pressure, blood tests. 609 00:31:35,694 --> 00:31:37,635 And then it's like, well, I know they can't get that out of my cat. 610 00:31:37,635 --> 00:31:39,135 So, I can't access that clinic. 611 00:31:39,404 --> 00:31:42,175 Or actually what I'd really like to be able to do is to go in and have a chat 612 00:31:42,475 --> 00:31:45,600 because I'm worried about something, but, now I can't go because they've said 613 00:31:45,600 --> 00:31:48,090 he's got to have all this stuff done and I know that's not going to suit me. 614 00:31:48,130 --> 00:31:51,690 So, um, thinking about tailoring that, which again can help to tailor costs. 615 00:31:52,010 --> 00:31:56,089 But I think it really is that idea that if we catch something early, then it may 616 00:31:56,090 --> 00:31:58,180 well be less expensive in the long run. 617 00:31:58,810 --> 00:32:03,065 But I think the big thing is really demonstrating what the value is going to 618 00:32:03,065 --> 00:32:06,955 be, what's going to be included and really making sure that what you say is going to 619 00:32:06,955 --> 00:32:10,694 happen is going to happen in terms of that verbal support, that time to listen and 620 00:32:10,945 --> 00:32:13,824 having the right person in the room, who's going to be knowledgeable enough to answer 621 00:32:13,894 --> 00:32:17,745 the questions, I think is what's going to make this a success or not really. 622 00:32:18,460 --> 00:32:20,300 Nathalie Dowgray: Yeah, I have to say I'd completely agree. 623 00:32:20,300 --> 00:32:24,970 I think we can set up a structure, but we need to be flexible within 624 00:32:24,970 --> 00:32:29,030 that structure based on the individual client needs, the cat's compliance, 625 00:32:29,240 --> 00:32:31,150 and also our findings as well. 626 00:32:31,150 --> 00:32:35,569 I think because I originally had a shelter medicine background, my 627 00:32:35,669 --> 00:32:39,440 thoughts on diagnostic tests are always, is this test going to change 628 00:32:39,450 --> 00:32:40,790 anything that I'm going to do? 629 00:32:41,150 --> 00:32:44,200 And if the answer is yes, then that's a test I want to run. 630 00:32:44,470 --> 00:32:49,160 If the answer's no, that test would be a nice to have, and for my information, 631 00:32:49,160 --> 00:32:51,530 a nice to know, but it's not essential. 632 00:32:51,570 --> 00:32:53,569 Zoe Belshaw: If it's not going to change what you do, then don't do it. 633 00:32:53,610 --> 00:32:56,720 I think there's an increasing concern in the profession about people not doing 634 00:32:56,729 --> 00:33:00,820 gold standard care within ourselves, about being negligent, about missing things. 635 00:33:00,820 --> 00:33:04,930 But actually, if that's informed consent with the client and you and the client 636 00:33:04,970 --> 00:33:09,050 have looked at what they can practically do with this individual patient, I think 637 00:33:09,050 --> 00:33:11,710 it's absolutely right to contextualise that care and say, did you know what? 638 00:33:12,135 --> 00:33:15,465 Yes, the idea would be to do that, but at the moment that's not the appropriate 639 00:33:15,465 --> 00:33:18,635 thing to do for this patient and this owner and to make peace with that, we 640 00:33:18,635 --> 00:33:23,574 can't always do what we might consider to be the best thing and what we consider 641 00:33:23,574 --> 00:33:27,855 to be the best thing might well not be the best thing actually for that kind 642 00:33:27,855 --> 00:33:31,855 of owner pet dyad, so I think we need to be much more at peace with that 643 00:33:31,885 --> 00:33:33,455 than we, than we perhaps currently are. 644 00:33:34,060 --> 00:33:37,910 Less is definitely more in, in some instances, but the history, the clinical 645 00:33:37,910 --> 00:33:40,060 exam, the, what are you worried about? 646 00:33:40,100 --> 00:33:46,370 The, what can I do to help is probably more valuable than any diagnostic 647 00:33:46,370 --> 00:33:47,880 test as at least as a basics. 648 00:33:49,010 --> 00:33:49,820 Nathalie Dowgray: Definitely. 649 00:33:50,029 --> 00:33:51,809 Thank you so much Zoe for your time. 650 00:33:52,060 --> 00:33:52,759 Zoe Belshaw: My pleasure. 651 00:33:58,375 --> 00:34:00,325 Nathalie Dowgray: Thanks for listening everyone and thank you 652 00:34:00,325 --> 00:34:03,945 IDEXX and Purina for supporting the production of this bonus episode. 653 00:34:04,515 --> 00:34:07,045 We'll be back again at the end of the month with our regular episode. 654 00:34:07,434 --> 00:34:10,384 If you don't want to miss out, do make sure you've signed up to Chattering with 655 00:34:10,384 --> 00:34:13,125 ISFM on your preferred podcast platform.